Steroid therapy in patients with intracranial hypertension from primary brain tumors and brain metastases

Background. Intracranial hypertension syndrome often develops in patients with brain malignant neoplasms. In three quarters of patients corticosteroid therapy reduces clinical manifestations of cerebral edema, usually within 48 hours, and is a prerequisite for starting radiation therapy after surgery, especially in patients with brain tumors with a significant mass effect. Intracranial hypertension significantly worsens the palliative patient’s life quality. The use of corticosteroids in this category of patients not only allows provide special treatment and improves the quality of life, but is also necessary for saving life. Currently, there are no clear detailed recommendations and protocols for the use of dexamethasone in this group of patients.

Materials and methods. The article provides an analytical review of foreign and Russian literature in order to inform doctors about existing approaches and recommendations for the use of dexamethasone in patients with malignant brain neoplasms with intracranial hypertension syndrome.

Discussion. Some questions of dexamethasone therapy are analyzed: whom dexamethasone is indicated for, what are the optimal doses of dexamethasone for the patients with intracranial hypertension, how to reduce the dose of dexamethasone, how to prevent and treat its adverse events.

Conclusion. At all stages of medical care doctors should strive to do everything possible to stabilize the disease, prolong life, as well as to improve its quality. All the patients in our practice require an individual approach. However, doctors need basic knowledge that they can use in their work adapting it to a specific clinical situation. Therefore, it is necessary to develop and implement a practical guide for the use of steroids in patients with malignant brain neoplasms both in the process of special treatment and in palliative care. Steroid therapy tactical issues should be included in the training program for palliative care doctors, since they most often supervise this cohort of patients.

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