Can progesterone be a better alternative to dexamethasone for use in routine brain surgery?

Abstract

Can progesterone be a better alternative to dexamethasone for use in routine brain surgery? Surgical brain injury (SBI) is a form of brain trauma caused by various forms of neurosurgical interventions including brain tumor excision, evacuation of intracerebral hemorrhage and brain lobectomy (e.g., in epilepsy surgery). Cerebral edema and brain swelling typically occurs soon after SBI and commonly peaks on post-operative days 3 to 7. SBI may cause secondary damages due to disruption of the blood-brain barrier (BBB), release of inflammatory cytokines (e.g., tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, toll-like receptor (TLR-2) and TLR-4) as well as increased expressions of Fas and Fas-L, free radical overload, dysfunctions of membrane ionic pumps and many other pathophysiological changes (Pan et al., 2007). Severe cerebral edema may eventually lead to elevated intracranial pressure (ICP), neurological deterioration or even death. Other long-term effects in survivors include sensori-motor and cognitive dysfunctions due to secondary, delayed degenerative changes. Given the large number of routine neurosurgical operations performed worldwide on a day-to-day basis, the prevention of SBI is just as important as the treatment of accident-related traumatic brain injury (TBI). The latter differs from SBI in that it is not amendable to pre-emptive therapy whereas SBI can theoretically be prevented, at least during routine elective surgery. The issue of using the best way to prevent cerebral edema and secondary damages in these situations are critical and deserve our research effort.