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