Warm Versus Cold Irrigation in Brain Surgery: A Comprehensive Review

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.
• 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.