gms | German Medical Science

Objective: Administration of corticosteroids is common practice in cranial neurosurgery to reduce edema during surgery and in the immediate postoperative period or to prevent post-operative nausea and vomiting (PONV). Corticosteroids are well known for their adverse effects. While currently no guidelines for steriod use in this context exist, the objective of this study was to assess the possible side effects of perioperative corticosteroids in a general neurosurgical patient collective.

Methods: In this retrospective analysis of surgically treated patients in the period between 08/2013-06/2014, patient age, sex, smoking, PONV and post-op complications (cerebro-spinal fluid (CSF) leakage, rebleeding, infection) were analyzed in relation to administration of dexamethasone (Dexa) using chi² tests, odds ratios (OR) and numbers needed to harm (NNH). Emergency surgeries, VP-Shunts and DBS, spinal or hypophysis surgeries and minors were excluded.

Results: 421 patients (193 male, 245 female, mean age 55 years range 17-90 years) were included, 343 tumor-, 29 epilepsy-, 49 vascular surgeries with 333 supratentorial and 88 infratentorial lesions, patients were stratified by the administration of Dexa, 303 patients received 40mg of Dexa, 21 received 4mg for prophylaxis of PONV, 5 of those also received 40mg during surgery, 102 did not receive steroids. The 40mg-Dexa group and No-Dexa group were balanced for age, gender, smoking habits, hospital stay and the number of supra and infratentorial surgeries, patients with 40mg of Dexa displayed a higher incidence of complications than those without any Dexa (15.2% vs. 5.9% p<0.01, OR 3,34, number needed to harm (NNH) 9.9) or 4mg-Dexa group (0.0%). CSF fistulas were more common for patients with 40mg of Dexa, 10.4% vs. 2.0% (p<0.05, OR 6,85, NNH 11.3). The rate of pneumonia was not raised for patients with steroids, but rebleeding occurred more often for 40mg of Dexa (5% vs. 1.7%, p=0.13).The incidence of PONV was 18.1% overall (23.5% No Dexa, 25.0% 4mg Dexa, 16.1% 40mg Dexa (p=0.09)). The presence of postoperative nausea and vomiting did not correlate with the incidence of complications such as rebleeding or CSF fistulas.

Conclusion: Dexa reduces the PONV rate, however in our study cohort perioperative Dexa is a significant risk factor for the development of CSF fistulas. PONV was not associated with pneumonia, CSF fistulas or rebleeding, therefore routine use of Dexamethasone is not recommended and should be administered only in selected cases.