Experimental exposure of the cat brain surface to neurosurgical irrigation fluids and air: study of blood-brain barrier damage.

Different fluids used in neurosurgery were tested for the production of blood-brain barrier dysfunction by applying them to the brain surface of the cat for 3 hours. Normal saline, Ringer's solution, and Elliott's Solution B induced no obvious damage either by closed subdural perfusion or when applied to the brain surface via pledgets for 3 hours. When perfusion with Ringer's solution for 2 hours and 45 minutes was preceded by 15 minutes of exposure to air, an intense extravasation of tracer was induced in the leptomeninges. When perfusion with Ringer's solution (2 hours and 45 minutes) was followed by irrigation with 3% hydrogen peroxide (5 minutes) and then brief perfusion (10 minutes) with Ringer's solution, thrombosis of leptomeningeal vessels and extensive extravasation of tracer were found in both the leptomeninges and the cortex down to the white matter. Elliott's Solution B seemed to provide better protection against these injuries than did Ringer's solution. Thee observations demonstrate the importance of immediate protection of the exposed brain surface against air by physiological fluids and show that these fluids provide effective protection against disturbance of the blood-brain barrier for at least 3 hours. Hydrogen peroxide proved unsuitable for application to the brain surface.