Cytoprotective effect and clinical outcome of perioperative progesterone in brain tumors, a randomized microscopically evidence study

Abstract

ABSTRACT Background and Aims Although progesterone role on TBI patients and its antitumor activity have been proved, its perioperative use in surgical brain tumors remains unclear. Primary outcome is to investigate any neuroprotective effects of perioperative intramuscular progesterone on the brain’s cellular inflammatory and neuro-excitotoxic response to tumor resection evidenced by neuronal cells immunohistochemistry and CT scanning. Secondary outcome is to explore the postoperative clinical course, any related complications, and post craniotomy short-term (3 months) outcome. Methods Two hundred fifty-two (252) adult patients, ASA class І-ІІ undergoing elective craniotomy were randomly allocated into two groups: progesterone (PR) and control (C) groups to receive either 1.0 mg/kg progesterone (diluted to a total volume of 2 ml) or 2 ml of isotonic saline daily intramuscular for five days before and after craniotomy. Results Histopathological biopsies revealed significant increase the expression of active nuclear PR receptors on oligodendrocytes and astrocytes (P-value = 0.0001), cytoplasmic and nuclear neuro-quiescence endorsed by keeping blood vessel integrity and preventing neutrophilic infiltration and cytoplasmic oedema (P-value = 0.005) in PR group. Follow up CT2 (on the morning of surgery) and CT3 (on the 3rd postoperative day) recorded a significant reduction of brain oedema (P = 0.0001&0.001). Also, significant earlier weaning with shorter ICU stay (P = 0.0001) and better postoperative 3 months outcome (P = 0.001) were demonstrated in progesterone group without any detectable complications. Conclusion Perioperative progesterone offered anti-neuroinflammatory and neuroprotective effect and reduced cytoplasmic brain oedema evidenced by histopathological biopsies and CT scanning. Also, it improved postoperative course and 3 months neurological outcome in surgical brain tumors.