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The Introduction of Steroids into Neurosurgical Practice

The Introduction of Steroids into Neurosurgical Practice Blood- Barrier is Deficient in Human Brain Tumors Moore, Peyton, French Glucosteroids improve patients with Symptomatic, Pre-Terminal Glioblastoma Galicich,French 1958-59. Glucosteroids improve non-tumorous brain swelling

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The Introduction of Steroids into Neurosurgical Practice

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  1. The Introduction of Steroids into Neurosurgical Practice Blood- Barrier is Deficient in Human Brain Tumors Moore, Peyton, French Glucosteroids improve patients with Symptomatic, Pre-Terminal Glioblastoma Galicich,French 1958-59

  2. Glucosteroids improve non-tumorous brain swelling Galicich, Long 1959 Randomized, Controlled Trial Begins and Ends Galicich, Long 1959 Prospective Trial Begins Galicich, Long, French 1960

  3. Laboratory Studies in Brain Edema Don Long 1960-1965 Choi Kilsoo 1967-1969 Robert Maxwell 1970-1972

  4. These studies proved the following: • Identified the Astrocyte-EM • Described the Human Brain Capillary-EM • Described the Ultra structural Features of Brain Edema • Demonstrated Beneficial Effects of Steroids • Described a B-B-B Effect of Steroids

  5. Clinical Studies in Brain Edema • RC Clinical Trial Abandoned 1960 • Prospective Efficacy Trial 1967-1972 • FDA Approval of the Drug for Brain Edema • (First drug ever taken through FDA process by a neurosurgeon)

  6. Impact of Glucosteroids In 45 years about 900,000 – 1,000,000 patients in the US In 1959 mortality was 10-30% - 90,000-300,000 deaths With steroids morality dropped to 3-10% - 27,000-100,000 deaths The effect upon morbidity can not be qualified but is substantial: XRT Between 60,000 and 200,000 lives saved in US Worldwide the number is well into the millions

  7. No other neurosurgical introduction has been so important in mortality Nothing else illustrates the French approach so well A fundamental clinical observation Application in new situations Study it in the laboratory Trust young associates to do it Support them in the face of criticism Share the credit and never boast about theaccomplishment

  8. My own career was intimately tied to this process I learned I was accepted in the residency through a lab assignment I was offered a staff position through extensions of the research The offer at Johns Hopkins was clearly related to this entire research project

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