Steroids

The administration of steroids for the purpose of reducing or limiting the formation of edema is another time-honored practice in neurosurgery. The efficacy of steroids in reducing the edema associated with tumors is well confirmed. ^{[49] [50] [51]} The time course of this effect is relatively rapid, though not so rapid that it is relevant to the management of intraoperative events. However, administration beginning 48 hours before an elective surgical procedure has the potential to reduce edema formation and improve the clinical condition by the time of craniotomy.^{[49] [50] [52]} Although clinical improvement, specifically, a decreased frequency of ICP plateau waves and an improvement in the pressure-volume response (the increment in ICP in response to a standardized intracranial volume challenge), occurs within 24 hours,^[49] a reduction in ICP may not occur for 48 to 72 hours after the initiation of therapy. ^[49] This has been interpreted to indicate that steroids in some way improve the "viscoelastic properties" of the intracranial space before a reduction in edema occurs, although the mechanism is undefined.^[52] Steroids are usually given intraoperatively and postoperatively to maintain the effects achieved by preoperative treatment.

The practice of administering steroids to adult head injury patients has largely been abandoned as a result of controlled trials that demonstrated either no benefit or deleterious effects.^{[53] [54] [55]} No such studies have been performed

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