The Genesis of the Use of Corticosteroids in the Treatment and Prevention of Brain Edema
Shearwood McClelland III M.D.1,
Donlin M. Long M.D., Ph.D. 2
1Department of Neurosurgery, University of Minnesota Medical School,
Minneapolis, MN; 2Department of Neurosurgery,
The Johns Hopkins Hospital, Baltimore, MD
Introduction:
Since
the groundbreaking manuscript from the University of Minnesota in 1961 by Drs.
Galicich, French and Melby describing the use of dexamethasone for peritumoral
cerebral edema, the use of corticosteroids in patients with brain tumors has
become routine. Unfortunately,
little has been reported regarding the environment that fostered arguably the
greatest translational research contribution in the history of neurosurgery.
Methods:
During
a pilot study to assess corticosteroid uptake in brain tumors, Dr. Galicich
observed that patients given a large dose of corticosteroids just prior to
craniotomy had a relatively benign postoperative course. This led, in October 1959, to the
administration of high-dose corticosteroids to a patient with a large recurrent
glioblastoma who was semi-comatose and severely hemiparetic. The results were dramatic, with almost
complete resolution of neurological deficit over a period of several days and
marked reduction of mid-line shift on repeat angiography. This finding prompted the studies that
confirmed the efficacy of high-dose corticosteroids in reducing peritumoral
brain edema in humans reported in the 1961 paper.
Results:
Following
publication, a revolution in brain tumor management took place, as
corticosteroid therapy markedly reduced the morbidity and mortality from brain
tumors both in the United States and worldwide.
Conclusion:
The
combination of astute clinical observation and follow-up by rigorous clinical
research at the University of Minnesota resulted in one of the greatest
contributions in the history of neurosurgery, rivaled only by the operative
microscope in impacting morbidity, and unsurpassed in worldwide reduction of
mortality.
Keywords:
Dexamethasone,
Peritumoral Cerebral Edema, Joseph Galicich, Lyle French, University of
Minnesota