Long-term corticosteroids for prevention of chemical meningitis in epidermoid: A treatment or a myth?

Abstract Context: Intracranial epidermoids are rare benign tumors with an incidence as low as 1%. Chemical meningitis is a possible complication following resection. Traditionally, long-term corticosteroids are used prophylactically for the prevention. Aims: To establish the necessity or not of long duration of postoperative corticosteroid therapy for preventing chemical meningitis. Settings and Design: We retrospectively reviewed 65 consecutive cases operated at our institute from June 2016 to December 2017. Materials and Methods: All the clinical-radiological information was collected from medical records. The cohort was divided naturally into two groups based on the duration of postoperative corticosteroids received by them. Both groups were assessed for surgical outcomes and the development of postoperative chemical meningitis or wound complications. Statistical Analysis Used: The normality of data was assessed using the Shapiro–Wilk test. Student t -test or Mann–Whitney U test was used to compare continuous variables between the groups. A chi-square test was used to compare categorical data between both groups. Results: Groups A ( n = 28) and B ( n = 37) received steroids for an average of four days (range: 3–7 days) and 30 days (range: 21–42 days), respectively. The mean follow-up for the whole cohort was 9.2 months (SD ± 12.14). The two groups were comparable statistically on all clinical parameters such as age ( P = 0.878), gender ( P = 0.459), extent of resection ( P = 0.246), contamination ( P = 0.557), intraoperative steroid use ( P = 0.185), post-op deficits ( P = 0.554), wound complications ( P = 0.345), and recurrence ( P = 0.182). However, the location of the tumor ( P = 0.041) and laterality ( P = 0.005) were different between both the groups along with the duration of hospital stay ( P = 0.036). Conclusions: Short duration of steroids postoperatively for less than a week is effective in preventing chemical meningitis. At the same time, if gross total resection (GTR) is not possible for any reason, short-term corticosteroids are enough to reduce the risk of postoperative chemical meningitis.