Intraoperative Neurophysiological Evidence of Hydrogen Peroxide-Induced Stroke in Insular Tumor Surgery

Hydrogen peroxide (H2O2) is commonly used as a haemostatic agent in all type of surgeries. Some adverse effects have been described related to its use. However, only very few cases are published in the literature of a stroke associated with the application of this agent directly to the brain. We present the case of a patient operated on for a right insular tumor with the assistance of intraoperative neurophysiological monitoring who developed a postoperative severe hemiparesis caused by a stroke in left middle cerebral artery territory due to the irrigation with H2O2. Based on this case, we recommend avoiding the H2O2 irrigation for hemostasis in surgery for brain tumors when vascular structures are exposed.