Possible detrimental effects of neurosurgical irrigation fluids on neural tissue: an evidence based analysis of various irrigants used in contemporary neurosurgical practice.
Physiological saline and other solutions used as irrigation fluids during neurosurgical procedures have long been debated to cause adverse effects on neural tissue. Laboratory based research over the past fifty years has described the possible harm caused to central nervous system cells by normal saline, and has advocated the use of safer alternatives such as lactated Ringer's solution and artificial cerebrospinal fluid. However, there is a dearth of corresponding clinical studies to support this standpoint. Worldwide, normal saline remains the most widely used neurosurgical irrigation fluid. We have attempted to document the preference of practicing neurosurgeons worldwide regarding the irrigation fluids via an electronic mail survey, and have analyzed the available evidence on the relative safety of various irrigation fluids. We recommend the use of lactated Ringer's solution and artificial cerebrospinal fluid as neurosurgical irrigants, especially during neuroendoscopy and longer procedures requiring application of copious amount of irrigation fluid.
Kazim
Syed Faraz
SF
Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Enam
Syed Ather
SA
Shamim
Muhammad Shahzad
MS
D001253:Astrocytes / Q000187:drug effects; D001812:Blood-Brain Barrier / Q000187:drug effects; D001921:Brain / Q000187:drug effects; D001929:Brain Edema / Q000209:etiology; D002470:Cell Survival / Q000187:drug effects; D002555:Cerebrospinal Fluid; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007552:Isotonic Solutions; D009474:Neurons / Q000187:drug effects; D019635:Neurosurgical Procedures; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000077331:Ringer's Solution; D012965:Sodium Chloride / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000379:methods*
D007552:Isotonic Solutions; D012965:Sodium Chloride; D000077331:Ringer's Solution