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

Abstract

Background: Hydrogen peroxide (H2O2) is a well-known hemostatic and antiseptic agent in neurosurgical practice. While there are concerns regarding the use of H2O2 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 H2O2 was conducted in a board-certified platform, and an experimental study was designed to investigate the effect of H2O2 on neuronal and tumor cells. Brain tissues of mice and brain/tumor tissues of humans were irrigated with H2O2 3%, H2O2 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 H2O2 in neurosurgical practice. however only 5% of the participants had a literature-based knowledge of the pathophysiological mechanism of H2O2. In total, eight mouse brain tissues, 21 human brain tissues, and seven human tumor tissues were processed and analyzed. The experimental study found that H2O2 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 H2O2 3% (p < 0.001). In human brain tissues, vacuolization was detected in sections exposed to H2O2 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 H2O2 group (p < 0.001). Similar results were observed in human tumor tissues as well. Conclusions: H2O2 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, H2O2 should be used with caution.