title: Intratumoral hydrogen peroxide injection during meningioma resection.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Lichtenbaum
authors.forename: Atos Alves
authors.initials: AA
authors.lastname: de Souza
authors.forename: Jafar J
authors.initials: JJ
authors.lastname: Jafar
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D006861:Hydrogen Peroxide / Q000008:administration & dosage*; D015552:Injections, Intralesional; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D006861:Hydrogen Peroxide