Pre-operative dosing of dexamethasone for the management of children with posterior fossa tumours: are we getting it right?

Makwana, Milan, Hussain, Humaira, Merola, Joseph P., Zaben, Malik ORCID: https://orcid.org/0000-0002-7446-4532, Jesurasa, Anthony R., Patel, Chirag and Leach, Paul 2022. Pre-operative dosing of dexamethasone for the management of children with posterior fossa tumours: are we getting it right? British Journal of Neurosurgery 36 (5) , pp. 609-612. 10.1080/02688697.2022.2040948

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Abstract

Introduction Posterior fossa (PF) tumours are associated with vasogenic oedema causing symptoms of raised intracranial pressure. Preoperatively this is managed with dexamethasone. To minimise steroid related complications, the lowest effective dose should be administered. No neurosurgical guidelines exist for pre-operative dosing of dexamethasone in PF tumours. Methods A retrospective review was performed of surgically managed cases for patients under 16 years of age between 2013 and 2018 to ascertain the initial dose of dexamethasone with symptomatic PF tumours. Results Thirty-six patients were identified of which 30 notes were available. Sixteen were male. Median age was 6 years (range 10 months − 15 years). Twenty-two (73%) were referrals from DGH and 8 (27%) presented to our neurosurgical centre. All patients presented with symptomatic PF tumours including headache (97%), vomiting (93%), gait disturbance (43%), and nystagmus (17%). Four (13%) had papilloedema. Average initial stat dexamethasone dose was 9.15 mg; 0.31 mg/kg (range 1–16.7 mg; 0.05 − 1.77 mg/kg). Stratified according to weight, average dose (and range) was 8.8 mg; 0.94 mg/kg (1–16.6 mg; 0.13 − 1.77 mg/kg) in those weighing <10 kg; 9.7 mg; 0.66 mg/kg (4–16.7 mg; 0.21 − 1.35 mg/kg) in 10–20 kg; 12.3 mg;0.52 mg/kg (8–16.7 mg; 0.27 − 0.73mg/kg) in 20–30 kg and 7.8 mg; 0.17mg/kg (2–16.7 mg; 0.0 − 0.39 mg/kg) in >30 kg up to a maximum of 16.6 mg in any 24h period. These results suggest that dosage was higher in those children weighing less. PPI was used in 24 (80%) of cases. All doses were reduced after review by the neurosurgical team and a PPI added. Conclusion Pre-operative dexamethasone dosing does not always reflect the severity of clinical symptoms for PF tumours. Guidelines are required to correlate clinical symptoms with a suggested suitable dose of dexamethasone to prevent overdose and complications associated with corticosteroid use. We recommend a weight-based regimen as provided by the Food and Drug Administration. The current advice is for 0.02–0.3mg/kg/day in 3–4 divided doses

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher:	Society of British Neurological Surgeons
ISSN:	0268-8697
Date of First Compliant Deposit:	26 July 2022
Date of Acceptance:	8 February 2022
Last Modified:	08 Nov 2023 14:18
URI:	https://orca.cardiff.ac.uk/id/eprint/151474

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