Hydrogen peroxide irrigation is commonly utilised in neurosurgical procedures and non-neurosurgical procedures for its bacteriocidal and hemostatic effect, however it has been associated with devastating complications such as tension pneumocephalus, O2 embolism and even dysrhythmias 1) 2).
Kleffman et al, present the case of an 81-year-old female patient who underwent lumbar spine surgery (microsurgical decompression) in an external hospital. H2O2 was used during the procedure. The patient was transferred to our hospital. She remained unconscious postoperatively, with progressive loss of brainstem reflexes. CT showed intraduraland extradurally trapped air ascending intradural from the operated lumbar segment up to frontal lobe. MRI demonstrated severe brainstem lesions on T2– and diffusion weighted magnetic resonance imaging. The patient died 10 days after surgery. Autopsy was not performed.
This case demonstrates a fatal complication with ischemic brainstem lesions and pneumocephalus following use of hydrogen peroxide. Therefore, H2O2 should only be used in cases without any signs of dural injury 4).
Patankar et al., report a case of air-embolism and subsequent ischaemic damage to the brain following intra-operative irrigation with hydrogen peroxide within a closed cavity of a spinal cold abscess of tuberculous origin. Copious amount of undiluted hydrogen peroxide irrigation was deployed under moderate pressure to clean-up the abscess cavity. Post-operatively, the patient developed seizures followed by clinical and radiological features of brain ischaemia ultimately resulting in a fatal outcome 5).