Mut Melike, Yemisci Muge, Gursoy-Ozdemir Yasemin, Ture Ugur
Department of Neurosurgery, Hacettepe University, Ankara, Turkey.
J Neurosurg. 2009 Jan;110(1):94-100. doi: 10.3171/2008.3.17434.
Hydrogen peroxide (H2O2) is used as a hemostatic agent in many neurosurgery centers. The authors used a 3% H2O2 solution for final hemostasis after removal of a left insular tumor. Immediately afterward, air bubbles were observed within the lumen of the polar temporal artery. Postoperative MR imaging revealed punctate areas of infarction in the lenticulostriate artery territory. The authors designed an experimental study to elucidate the mechanism of remote O2 emboli and reactive O2 species-related vasoactive responses and thrombus formation.
In this study, H2O2 irrigation was used in mice with either an intact pial layer or after the pia mater was removed through a corticotomy. Normal saline irrigation was used in the corresponding control groups. Vessels were examined for intravascular O2 emboli under the microscope. Tissue sections were then obtained and stained with H & E and the 3-nitrotyrosine (3-NT) antibody to evaluate intravascular thrombus formation and peroxynitrite reaction, respectively.
Multiple bubbles were observed within the lumen of the vessels after exposure to H2O2 regardless of whether the pial layer was destroyed or intact. Immunofluorescent staining for 3-NT showed an abundant positive reaction in the vessel walls of all animals exposed to H2O2 as well as vascular occlusion with acute thrombus formation. Samples taken from the animals that received saline showed no positive staining for 3-NT and no vascular occlusion.
Exposure to H2O2 may cause serious ischemic complications. The formation of peroxynitrite may cause vasoactive responses to H2O2 and platelet aggregation/thrombus formation, and the free diffusion of H2O2 through the vessel walls and its conversion to water and O2 leads to O2 bubbles within the closed vessel lumen. If used intradurally, H2O2 may have deleterious ischemic effects, and it can only be used carefully in open extradural spaces.
过氧化氢（H2O2）在许多神经外科中心被用作止血剂。作者在切除左侧岛叶肿瘤后，使用3%的H2O2溶液进行最终止血。随后立即观察到颞极动脉管腔内出现气泡。术后磁共振成像显示豆纹动脉区域有散在梗死灶。作者设计了一项实验研究，以阐明远处氧栓子以及活性氧相关血管活性反应和血栓形成的机制。
在本研究中，对软脑膜完整或通过皮质切开术去除软脑膜后的小鼠使用H2O2冲洗。相应的对照组使用生理盐水冲洗。在显微镜下检查血管内的氧栓子。然后获取组织切片，并用苏木精和伊红（H&E）以及3-硝基酪氨酸（3-NT）抗体染色，分别评估血管内血栓形成和过氧亚硝酸盐反应。
无论软脑膜是否被破坏或完整，暴露于H2O2后血管管腔内均观察到多个气泡。3-NT的免疫荧光染色显示，所有暴露于H2O2的动物血管壁均有丰富的阳性反应以及急性血栓形成导致的血管闭塞。取自接受生理盐水处理动物的样本3-NT染色无阳性，也无血管闭塞。
暴露于H2O2可能导致严重的缺血性并发症。过氧亚硝酸盐的形成可能导致对H2O2的血管活性反应以及血小板聚集/血栓形成，并且H2O2通过血管壁的自由扩散及其转化为水和氧气会导致封闭的血管管腔内出现氧气气泡。如果在硬膜内使用，H2O2可能具有有害的缺血性影响，并且只能在开放硬膜外间隙谨慎使用。
