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Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy


Prabhakar, H., et al

Subject Keywords: Mannitol, Hypertonic saline, Intraoperative brain relaxation, Patient, Craniotomy
Type: Article
Region: International (other)

Review question: We reviewed evidence on the effectiveness of mannitol and hypertonic saline for brain relaxation in people having surgery (craniotomy) for brain tumour.

Background: People with brain tumour undergo a craniotomy, or opening of the skull bone, for its removal. A relaxed brain allows the surgeon to remove the skull bone easily and to remove the tumour without damaging other brain tissue. Brain relaxation is achieved often by using mannitol, which is a hypertonic fluid. Hypertonic solutions are those that have higher solute concentrations when compared with body fluids and tissue. Some surgeons use hypertonic saline instead of mannitol. We wanted to discover whether using hypertonic saline was better or worse than using mannitol.

Study characteristics: The evidence is current to October 2013. We included studies in children (age > 28 days and < 18 years) and adult patients (age > 18 years) of either gender who received mannitol or hypertonic saline during craniotomy for brain tumour.

Key results: We found six studies with 527 participants.

Three studies reported the level of brain relaxation. Hypertonic saline may provide better brain relaxation than mannitol.

The length of intensive care unit stay and hospital stay was reported by one study.

No study reported on the effects of mannitol and hypertonic saline on mortality, the condition of the patient three months after the operation or patient quality of life. Based on our results, we would expect that of 100 patients who received hypertonic saline during surgery, around 22 patients would fail to have adequate brain relaxation compared with 36 patients given mannitol.

Quality of evidence

The quality of evidence for brain relaxation with use of hypertonic saline is low. Further research is needed to assess more important issues such as long-term mortality, long-term outcomes, adverse events and quality of life with use of the two fluids.



Rights: © The Cochrane Collaboration
Suggested citation:

Prabhakar, H., et al. (2014) Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy [Online]. Available from: [Accessed: 17th October 2019].


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