Intratumoral Hydrogen Peroxide Injection During Meningioma Resection

Abstract

Meningiomas, although histologically benign, pose a particular challenge to the neurosurgeon because of their extensive and exuberant vascularity. They often bleed extensively during resection until separated from their blood supply. There are a wide variety of hemostatic agents available to the neurosurgeon. Most of these means of hemostasis involve some sort of chemical, electrical, or compressive action. Although anecdotally known to be useful, the use of hydrogen peroxide as an intracranial hemostatic agent in meningioma surgery has not been formally reported. We report a technique of meningioma resection that uses intratumoral hydrogen peroxide injection, reducing the potential for blood loss and shortening resection times. Seventy-five patients underwent resection of a meningioma using the direct intratumoral H2O2 injection technique. The locations of these meningiomas included convexity and cranial-based lesions. None of the patients underwent preoperative endovascular embolization. The use of this technique greatly facilitated the removal of these tumors. No evidence of air embolism occurred during Doppler surveillance and no other significant side effects attributable to H2O2 application were observed. We demonstrate a previously unreported technique of meningioma resection that uses direct intratumoral hydrogen peroxide injection, potentially reducing blood loss, shortening resection times, and obviating the need for preoperative embolization.