The Value of Hydrogen Peroxide in Neurosurgery and Its Pathophysiological Effects in Human and Animal Brain Tissues

Background : Hydrogen peroxide (H 2 O 2 ) is a well-known hemostatic and antiseptic agent in neurosurgical practice. While there are concerns regarding the use of H 2 O 2 due to its potential for neuronal damage, the pathophysiological effect on neuronal cells is not clearly understood. Methods : An online survey concerning the use of H 2 O 2 was conducted in a board-certified platform, and an experimental study was designed to investigate the effect of H 2 O 2 on neuronal and tumor cells. Brain tissues of mice and brain/tumor tissues of humans were irrigated with H 2 O 2 3%, H 2 O 2 1.5%, and NaCl 0.9%, and processed by bipolar coagulation. Tissue sections were obtained and stained with H&E and analyzed by the depth and degree of neuronal damage measured from the cortical surface (μm). Results : In total, 242 neurosurgeons participated in the survey, and 81% of neurosurgeons reported use of H 2 O 2 in neurosurgical practice. however only 5% of the participants had a literature-based knowledge of the pathophysiological mechanism of H 2 O 2 . In total, eight mouse brain tissues, 21 human brain tissues, and seven human tumor tissues were processed and analyzed. The experimental study found that H 2 O 2 caused vacuolization of neuronal tissue in mouse brain tissues, with a mean depth of damage of 343.7 ± 39.7 μm after 2 min and 460.1 ± 36.4 μm after 10 min exposure to H 2 O 2 3% ( p < 0.001). In human brain tissues, vacuolization was detected in sections exposed to H 2 O 2 1.5% and 3%, with a mean depth of damage of 543.8 ± 304.5 μm and 859.0 ± 379 μm ( p = 0.003). In the bipolar coagulation group, the mean depth of neuronal damage, of 2504 ± 1490 μm, was nearly three times greater than that in the H 2 O 2 group ( p < 0.001). Similar results were observed in human tumor tissues as well. Conclusions : H 2 O 2 seems to cause less local damage on neuronal and tumor cells than conventional bipolar cauterization, suggesting it as a good alternative to be used for hemostasis and marginal tumor cell treatment. However, due to its potential risk for embolism, H 2 O 2 should be used with caution.