Do prophylactic steroids prevent chemical meningitis in surgery for epidermoid cysts? Case report and literature review

Renata Ganko*, Michael Rodriguez, John Magnussen, Mary Simons, Esther Myint, Nazih Assaad

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Cranial and spinal epidermoid cysts (ECs) are rare and surgical resection can be complicated by chemical meningitis. Here, we treated a patient undergoing surgical resection of an intramedullary spinal EC with prophylactic steroids to help prevent postoperative chemical meningitis. Notably, we found a paucity of evidence regarding the efficacy of steroids used for this purpose. Case Description: A 44-year-old male presented with a rare intramedullary thoracic EC. He was given oral dexamethasone postoperatively and did not subsequently develop chemical meningitis. Here, we reviewed the current literature regarding the efficacy of steroid use for this purpose, utilizing multiple electronic databases (Ovid MEDLINE, Ovid EMBASE, and Scopus). We found only three studies (one case report, one case series, and a randomized controlled trial), that involved patients who received steroids. Of the 24 patients given prophylactic steroids, none developed fever or meningismus. One patient received 8 days of oral dexamethasone. Eleven patients received intraoperative hydrocortisone irrigation alone, while final 12 patients received intraoperative hydrocortisone irrigation plus a 3 week postoperative tapering course of oral steroids. Notably, all of the nine patients who did not receive any steroids developed postoperative fever, with 78% demonstrating meningismus. Conclusion: Here is level II evidence that establishes the efficacy of prophylactic steroids utilized in patients undergoing surgery for ECs to prevent postoperative chemical meningitis. Nevertheless, there is still no current consensus regarding either the type of steroid utilized, or the route of administration.

Original languageEnglish
Article number472
Pages (from-to)1-4
Number of pages4
JournalSurgical Neurology International
Volume11
DOIs
Publication statusPublished - 1 Dec 2020

Bibliographical note

Copyright 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Chemical meningitis
  • Dexamethasone
  • Epidermoid cyst
  • Hydrocortisone
  • Level of evidence

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