title: Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery.
abstract: BACKGROUND
  The hemostatic properties of hydrogen peroxide (H2O2) are often used in neurosurgical practice.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany. Electronic address: jkleffmann@gmail.com.
authors.forename: Jens
authors.initials: J
authors.lastname: Kleffmann
authors.affiliation: Deparment of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ferbert
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Deinsberger
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany; Deparment of Neurology, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Roth
mesh_terms: D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology*; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000601:surgery*; D011007:Pneumocephalus / Q000209:etiology*
chemical_list: D006861:Hydrogen Peroxide
keywords: Hydrogen peroxide; Ischemic brainstem lesion; Lumbar surgery; Pneumocephalus; Spinal stenosis; Stroke