Vascular endothelial growth factor (VEGF), one of the important growth factors regulating angiogenesis, is expressed in the neomembranes and also in hematoma fluid, and the MAP ERK pathway has been implicated in angiogenesis by VEGF.

The report of Weigel et al. was the first to suggest a pathophysiological link between the VEGF concentration and the exudation rate underlying the steady increase of chronic subdural hematoma volume and CT appearance.With this finding, the current report adds another piece of evidence in favor of the pathophysiological role of VEGF in the development of CSH, including mechanisms contributing to hematoma growth and CT appearance ¹⁾.

The precise mechanisms remain to be determined.

Saito et al. suggest that the TGF beta-ALK1 pathway and VEGF affect neovascularization and the progression of CSH. ²⁾

Finding supports the hypothesis that high VEGF concentration in the hematoma fluid is of major pathophysiological importance in the generation and steady increase of the hematoma volume, as well as the determination of MRI appearance ³⁾.