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

<b>Background</b>: 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. <b>Methods</b>: 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). <b>Results</b>: 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% (<i>p</i> < 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 (<i>p</i> = 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 (<i>p</i> < 0.001). Similar results were observed in human tumor tissues as well. <b>Conclusions</b>: 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.