Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery.

Abstract

The hemostatic properties of hydrogen peroxide (H2O2) are often used in neurosurgical practice. We present the case of an 81-year-old woman who underwent lumbar spinal 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. Computed tomography showed intra- and extradurally trapped air ascending from the operated lumbar segment up to frontal lobe. Magnetic resonance imaging demonstrated severe brainstem lesions on T2- and diffusion-weighted series. The patient died 10 days after surgery. Autopsy was not performed. Our case demonstrates a fatal complication with ischemic brainstem lesions and pneumocephalus after the use of hydrogen peroxide. Therefore, H2O2 should only be used in cases without any signs of dural injury.