RMTD-05 Peri-Operative Dexamethasone Use in Brain Metastasis Surgery: Analysis of Practice Variation Across Eight Neurosurgical Centers

BACKGROUND Peri-operative corticosteroids are routinely administered in brain metastasis surgery to manage edema, yet standardized dosing protocols are lacking. Practice variation between neurosurgical centers has not been systematically quantified. METHODS We retrospectively analyzed 1,064 patients who underwent brain metastasis resection across eight academic neurosurgical centers in Germany and Austria (2010–2023). Dexamethasone dosing was captured daily from day –13 to +13 relative to surgery. Cumulative doses were compared across centers, and variation assessed using ANOVA and Tukey’s post-hoc tests. Mean and median values were visualized longitudinally and stratified by time segment (pre- vs. post-op). RESULTS Marked differences in cumulative peri-operative dexamethasone use were observed across centers (range of mean total dose: 74.6–211.1 mg, p < 0.0001). Median pre-operative doses ranged from 20.0 mg to 96.0 mg, while post-operative doses varied between 40.0 mg and 138.0 mg. Daily dosing curves revealed significant heterogeneity in tapering strategies and initiation timing. These differences occurred despite similar patient characteristics, surgical indications, and tumor types. CONCLUSION This multicenter study reveals substantial inter-center variation in peri-operative dexamethasone use during brain metastasis resection. The observed differences highlight the absence of standardized protocols and underscore the need for prospective evaluation of corticosteroid strategies in neuro-oncology practice. * authors 1 and 2 share first-authorship