Irrigation is used in every brain surgery operation, yet the optimal temperature of irrigation fluid remains poorly defined and is a topic of debate among neurosurgeons. The majority of neurosurgeons who use warm irrigation cite maintaining normothermia and its perceived hemostatic benefit as their main reasons. However, basic science, neurophysiology, and clinical data challenge the rationale for warm irrigation and suggest that cold irrigation is more advantageous given its neuroprotective properties. Hyperthermia exacerbates neuronal injury, increases metabolic demand, lowers seizure threshold, and worsens outcomes following CNS injury. Conversely, hypothermia reduces intracranial pressure, decreases cerebral metabolism, limits oxidative damage, and improves outcomes in numerous injury models. This review synthesizes the available literature on irrigation temperature in cranial neurosurgery and argues that cold irrigation is superior because it is physiologically consistent with the principles of neuroprotection, metabolic suppression, and seizure prevention.
Abstract
Journal Article
Review
eng
42326146
Shay, Allison, et al. "Warm Versus Cold Irrigation in Brain Surgery: a Comprehensive Review." Cureus, vol. 18, no. 5, 2026, pp. e109145.
Shay A, Johnston HK, Patel AG, et al. Warm Versus Cold Irrigation in Brain Surgery: A Comprehensive Review. Cureus. 2026;18(5):e109145.
Shay, A., Johnston, H. K., Patel, A. G., Reier, L., Arshad, M., & Siddiqi, J. (2026). Warm Versus Cold Irrigation in Brain Surgery: A Comprehensive Review. Cureus, 18(5), e109145. https://doi.org/10.7759/cureus.109145
Shay A, et al. Warm Versus Cold Irrigation in Brain Surgery: a Comprehensive Review. Cureus. 2026;18(5):e109145. PubMed PMID: 42326146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Warm Versus Cold Irrigation in Brain Surgery: A Comprehensive Review.
AU - Shay,Allison,
AU - Johnston,Heather K,
AU - Patel,Akshar G,
AU - Reier,Louis,
AU - Arshad,Mohammad,
AU - Siddiqi,Javed,
Y1 - 2026/05/18/
PY - 2026/2/23/received
PY - 2026/4/30/accepted
PY - 2026/6/22/medline
PY - 2026/6/22/pubmed
PY - 2026/6/22/entrez
PY - 2026/5/18/pmc-release
KW - cold irrigation
KW - hypothermia
KW - intraoperative thermoregulation
KW - irrigation temperature
KW - neuroprotection
KW - selective brain cooling
KW - warm irrigation
SP - e109145
EP - e109145
JF - Cureus
JO - Cureus
VL - 18
IS - 5
N2 - Irrigation is used in every brain surgery operation, yet the optimal temperature of irrigation fluid remains poorly defined and is a topic of debate among neurosurgeons. The majority of neurosurgeons who use warm irrigation cite maintaining normothermia and its perceived hemostatic benefit as their main reasons. However, basic science, neurophysiology, and clinical data challenge the rationale for warm irrigation and suggest that cold irrigation is more advantageous given its neuroprotective properties. Hyperthermia exacerbates neuronal injury, increases metabolic demand, lowers seizure threshold, and worsens outcomes following CNS injury. Conversely, hypothermia reduces intracranial pressure, decreases cerebral metabolism, limits oxidative damage, and improves outcomes in numerous injury models. This review synthesizes the available literature on irrigation temperature in cranial neurosurgery and argues that cold irrigation is superior because it is physiologically consistent with the principles of neuroprotection, metabolic suppression, and seizure prevention.
SN - 2168-8184
UR - https://www.unboundmedicine.com/prime/citation/42326146/Warm_Versus_Cold_Irrigation_in_Brain_Surgery:_A_Comprehensive_Review.
DB - PRIME
DP - Unbound Medicine
ER -
