Cortical damage from Zenker's solution applied to the dura mater

Area of Science:

• Neuroscience
• Surgical Pathology

Background:

• The safety of modified Zenker's solution, a fixative used in neurosurgery, has been questioned.
• Previous studies have not definitively established its potential for cortical injury when applied externally to the dura mater.

Purpose of the Study:

• To investigate whether modified Zenker's solution applied to the dura mater can penetrate and damage the underlying cerebral cortex.
• To assess the clinical relevance of this potential complication in patients undergoing craniosynostosis repair.

Main Methods:

• Experimental application of modified Zenker's solution to the dura of cats and dogs, with Evans blue dye used to detect blood-brain barrier breakdown.
• In vitro application of modified Zenker's solution to fresh human dura mater at autopsy.
• Clinical observation of seizure incidence in patients treated with and without modified Zenker's solution during craniosynostosis surgery.

Main Results:

• Massive cortical staining was observed in animal models within 1-2 hours post-application, indicating penetration and blood-brain barrier disruption.
• Visual evidence of cortical penetration was noted within 1 hour after applying the solution to fresh dura at autopsy.
• A higher incidence of immediate postoperative seizures (7/69) was observed in patients treated with modified Zenker's solution compared to those who were not (0/39).

Conclusions:

• Modified Zenker's solution applied to the dura mater can penetrate and cause damage to the underlying cerebral cortex.
• The findings suggest a potential risk of neurological complications, such as seizures, associated with the use of this solution in neurosurgical procedures.