Is There Still a Place for the Use of Hydrogen Peroxide in Neurosurgery?

Hydrogen peroxide (H2O2) has been used in neurosurgery for over a century as a hemostatic and antimicrobial agent. Despite its long history, its role in modern neurosurgical practice remains controversial due to significant safety concerns. This review examines the chemical and biological mechanisms of H2O2, its clinical applications in neurosurgery, associated risks, including gas embolism and neurotoxicity, and current best practice recommendations. While H2O2 demonstrates efficacy for hemostasis and infection control, the availability of safer alternatives and the risk of potentially fatal complications, particularly venous oxygen embolism and cardiovascular collapse, suggest that routine use is difficult to justify. Contemporary evidence supports a highly restrictive approach, with a strong trend toward replacing H2O2 entirely with saline irrigation and modern hemostatic techniques.