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Updated: Jun 23, 2026

2-Vessel Occlusion/Hypotension: A Rat Model of Global Brain Ischemia
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Warm Versus Cold Irrigation in Brain Surgery: A Comprehensive Review.

Allison Shay1, Heather K Johnston2, Akshar G Patel3

  • 1Department of Clinical Sciences, St. George's University School of Medicine, St. George's, GRD.

Cureus
|June 22, 2026
PubMed
Summary

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Cold irrigation fluid in brain surgery offers neuroprotection and seizure prevention, challenging the traditional use of warm fluids. This review synthesizes evidence suggesting cold irrigation is superior for patient outcomes.

Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Critical Care Medicine

Background:

  • The optimal temperature for irrigation fluid during brain surgery is debated among neurosurgeons.
  • Warm irrigation is often preferred for normothermia and hemostasis, but scientific evidence is lacking.
  • Existing data challenge the benefits of warm irrigation and suggest potential harm.

Purpose of the Study:

  • To review the literature on irrigation fluid temperature in cranial neurosurgery.
  • To evaluate the neuroprotective and physiological effects of cold versus warm irrigation.
  • To argue for the superiority of cold irrigation in neurosurgery.

Main Methods:

  • Literature synthesis of basic science, neurophysiology, and clinical data.
  • Review of studies on irrigation temperature in cranial neurosurgery.
Keywords:
cold irrigationhypothermiaintraoperative thermoregulationirrigation temperatureneuroprotectionselective brain coolingwarm irrigation

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  • Analysis of the effects of hyperthermia and hypothermia on the central nervous system (CNS).

    • Main Results:

    • Hyperthermia worsens neuronal injury, increases metabolic demand, and lowers seizure threshold.
    • Hypothermia reduces intracranial pressure, decreases cerebral metabolism, and limits oxidative damage.
    • Cold irrigation aligns with neuroprotection, metabolic suppression, and seizure prevention principles.

    Conclusions:

    • Cold irrigation is physiologically advantageous for neuroprotection and seizure prevention.
    • Evidence supports cold irrigation over warm irrigation in cranial neurosurgery.
    • Optimal irrigation temperature can improve outcomes in central nervous system (CNS) injury.