Effect of glucocorticoids on ICP in patients with a cerebral tumour.

Preoperative treatment with glucocorticoids in patients with an intracranial tumour has been neurosurgical practice for more than 30 years. Recently, however, a less beneficial effect in patients with a meningeoma is reported. This study included 4 patients with a glioma, 4 with a metastasis and 5 with a meningeoma. All patients had a substantial amount of oedema. The effect of methylprednisolone was monitored during 5 days by clinical examination and epidural pressure measurement. ICP reduction was found in 4 of 13 patients. All observations of decreasing pressure were in patients with a malignant tumour and an initial ICP > 15 mmHg. All 4 patients improved clinically. Another 4 patients with a benign meningioma had a significant increase of ICP and none of them experienced clinical improvement. Clinical deterioration was not observed in any patient despite increasing ICP in some cases. In summary, a beneficial effect of GC was demonstrated only in patients with a malignant tumour and augmented pre-treatment ICP.