RMTD-05 PERI-OPERATIVE DEXAMETHASONE USE IN BRAIN METASTASIS SURGERY: ANALYSIS OF PRACTICE VARIATION ACROSS EIGHT NEUROSURGICAL CENTERS

Abstract BACKGROUND Peri-operative corticosteroids are routinely administered in brain metastasis surgery to manage edema, yet standardized dosing protocols are lacking. Practice variation between neurosurgical centers has not been systematically quantified. METHODS We retrospectively analyzed 1,064 patients who underwent brain metastasis resection across eight academic neurosurgical centers in Germany and Austria (2010–2023). Dexamethasone dosing was captured daily from day –13 to +13 relative to surgery. Cumulative doses were compared across centers, and variation assessed using ANOVA and Tukey’s post-hoc tests. Mean and median values were visualized longitudinally and stratified by time segment (pre- vs. post-op). RESULTS Marked differences in cumulative peri-operative dexamethasone use were observed across centers (range of mean total dose: 74.6–211.1 mg, p < 0.0001). Median pre-operative doses ranged from 20.0 mg to 96.0 mg, while post-operative doses varied between 40.0 mg and 138.0 mg. Daily dosing curves revealed significant heterogeneity in tapering strategies and initiation timing. These differences occurred despite similar patient characteristics, surgical indications, and tumor types. CONCLUSION This multicenter study reveals substantial inter-center variation in peri-operative dexamethasone use during brain metastasis resection. The observed differences highlight the absence of standardized protocols and underscore the need for prospective evaluation of corticosteroid strategies in neuro-oncology practice. * authors 1 and 2 share first-authorship

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Journal
Neuro-Oncology Advances
Published
2025-08-01
DOI
https://doi.org/10.1093/noajnl/vdaf123.111
Primary Topic
Glioma Diagnosis and Treatment
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article
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article

RMTD-05 PERI-OPERATIVE DEXAMETHASONE USE IN BRAIN METASTASIS SURGERY: ANALYSIS OF PRACTICE VARIATION ACROSS EIGHT NEUROSURGICAL CENTERS

Ran Xu, Paul Poeser, Benedikt Asey, Peter Vajkoczy et al.
Neuro-Oncology Advances
Glioma Diagnosis and Treatment
article

RMTD-05 PERI-OPERATIVE DEXAMETHASONE USE IN BRAIN METASTASIS SURGERY: ANALYSIS OF PRACTICE VARIATION ACROSS EIGHT NEUROSURGICAL CENTERS

Ran Xu, Paul Poeser, Benedikt Asey, Peter Vajkoczy, Claudius Jelgersma, Jan Bukatz, Anne Pohrt, Matthias Simon, Anne Neumeister, Nikolaj Frost, Johannes Kerschbaumer, Christopher M. Kramer, Alice Dauth, David Capper, Lars Bullinger, Christian F. Freyschlag, Zoe Shaked, Martin Misch, Christian Senft, Nils Ole Schmidt, Ulrich Keilholz, Julia Onken, Felix Ehret, Jens Gempt, Claudius Thomé, Anton Früh, Florian Ringel, Daniel Dubinski, Artem Rafaelian, Martin Proescholdt, Hanno S. Meyer, Harald Krenzlin, Thomas M. Freiman, Ricarda Peukert, David Wasilewski, Tommaso Araceli, Tunc-Faik Ersoy, Leon Schmidt, Matthias Demetz
article en

Abstract

Abstract BACKGROUND Peri-operative corticosteroids are routinely administered in brain metastasis surgery to manage edema, yet standardized dosing protocols are lacking. Practice variation between neurosurgical centers has not been systematically quantified. METHODS We retrospectively analyzed 1,064 patients who underwent brain metastasis resection across eight academic neurosurgical centers in Germany and Austria (2010–2023). Dexamethasone dosing was captured daily from day –13 to +13 relative to surgery. Cumulative doses were compared across centers, and variation assessed using ANOVA and Tukey’s post-hoc tests. Mean and median values were visualized longitudinally and stratified by time segment (pre- vs. post-op). RESULTS Marked differences in cumulative peri-operative dexamethasone use were observed across centers (range of mean total dose: 74.6–211.1 mg, p < 0.0001). Median pre-operative doses ranged from 20.0 mg to 96.0 mg, while post-operative doses varied between 40.0 mg and 138.0 mg. Daily dosing curves revealed significant heterogeneity in tapering strategies and initiation timing. These differences occurred despite similar patient characteristics, surgical indications, and tumor types. CONCLUSION This multicenter study reveals substantial inter-center variation in peri-operative dexamethasone use during brain metastasis resection. The observed differences highlight the absence of standardized protocols and underscore the need for prospective evaluation of corticosteroid strategies in neuro-oncology practice. * authors 1 and 2 share first-authorship

Neuro-Oncology AdvancesVol. 7(Supplement_2)
Innsbruck Medical University (AT), Universität Hamburg (DE), German Cancer Research Center (DE), Universität Innsbruck (AT), Johannes Gutenberg University Mainz (DE), Bielefeld University (DE), Heidelberg University (DE), University Hospital Regensburg (DE), Humboldt-Universität zu Berlin (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Evangelisches Krankenhaus Bielefeld (DE), University Medical Center Hamburg-Eppendorf (DE), Jena University Hospital (DE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), University of Rostock (DE), University of Regensburg (DE), Freie Universität Berlin (DE), Friedrich Schiller University Jena (DE), Charité - Universitätsmedizin Berlin (DE)
Good health and well-being
Openalex Percentile: Top 72%
Glioma Diagnosis and Treatment
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