Ganko Renata, Rodriguez Michael, Magnussen John, Simons Mary, Myint Esther, Assaad Nazih
Department of Neurosurgery, Macquarie University Hospital, Macquarie Park, New South Wales, Australia.
Department of Anatomical Pathology, Douglas Hanly Moir Pathology (Sonic Healthcare), New South Wales, Australia.
Surg Neurol Int. 2020 Dec 29;11:472. doi: 10.25259/SNI_797_2020. eCollection 2020.
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.
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.
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.
颅骨和脊髓表皮样囊肿（ECs）较为罕见，手术切除可能并发化学性脑膜炎。在此，我们对一名接受脊髓内EC手术切除的患者使用预防性类固醇药物，以帮助预防术后化学性脑膜炎。值得注意的是，我们发现关于用于此目的的类固醇药物疗效的证据很少。
一名44岁男性患有罕见的胸段脊髓内EC。术后给予其口服地塞米松，随后未发生化学性脑膜炎。在此，我们利用多个电子数据库（Ovid MEDLINE、Ovid EMBASE和Scopus）回顾了关于为此目的使用类固醇药物疗效的当前文献。我们仅发现三项研究（一篇病例报告、一篇病例系列和一项随机对照试验）涉及接受类固醇药物治疗的患者。在24例接受预防性类固醇药物治疗的患者中，无一例出现发热或颈项强直。1例患者接受了8天的口服地塞米松治疗。11例患者仅在术中接受氢化可的松冲洗，而最后12例患者在术中接受氢化可的松冲洗并在术后接受为期3周的口服类固醇药物递减疗程。值得注意的是，9例未接受任何类固醇药物治疗的患者均出现术后发热，其中78%表现为颈项强直。
这是二级证据，证实了在接受EC手术的患者中使用预防性类固醇药物预防术后化学性脑膜炎的疗效。然而，对于所使用类固醇药物的类型或给药途径，目前仍未达成共识。
