Intratumoral Hydrogen Peroxide Injection during Meningioma Resection

Objective: Meningiomas, although histologically benign, pose a particular challenge to the neurosurgeon because of their extensive vascularity. Intraoperative removal difficulties are usually encountered due to their vascular nature: 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 methods involve some sort of chemical, electrical, or compressive action. Although 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.

Methods: Four patients underwent resection of a meningioma using the direct intratumoral H₂O₂ injection technique. All four cases were olfactory groove meningiomas. None of the patients underwent preoperative endovascular embolization.

Results: The use of this technique greatly facilitated the removal of these tumors. No significant side effects attributable to H₂O₂ application were observed.

Conclusion: 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.