Dexamethasone, a long-acting potent glucocorticoid, is one of the most widely used medications in neurosurgery. In this paper, the authors recount the history of dexamethasone's rise in neurosurgery and discuss its use in brain tumors in the context of emerging neuro-oncological immunotherapies. In 1958, Glen E. Arth synthesized a 16-alpha-methylated analog of cortisone (dexamethasone) for treatment of rheumatoid arthritis. Joseph Galicich, a neurosurgery resident at the time, applied the rheumatological drug to neurosurgery. He gave doses to patients who had undergone craniotomy for tumor removal and saw their paresis improve, midline shift resolve, and mortality rates decrease. He advocated for clinical trials and the drug became a mainstay in neurosurgery. As neuro-oncological treatments evolve to include immunotherapy, the immunosuppressive effects of dexamethasone are becoming an unwanted effect. The question then becomes: how does one treat the patient's symptoms if the only drug that has been used throughout history may become a detriment to their oncological treatment? Since its discovery, dexamethasone has maintained an impressive staying power in the field, acting as a standard drug for cerebral edema for more than 60 years. However, with the advent of immunotherapy, research is warranted to evaluate ways of treating symptomatic edema in the context of modern neuro-oncological therapies.

中文翻译：

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地塞米松的故事以及它如何成为神经外科最广泛使用的药物之一。

地塞米松是一种长效强效糖皮质激素，是神经外科最广泛使用的药物之一。在本文中，作者回顾了地塞米松在神经外科领域兴起的历史，并讨论了它在新兴神经肿瘤免疫疗法背景下在脑肿瘤中的应用。1958年，Glen E. Arth合成了可的松（地塞米松）的16-α-甲基化类似物，用于治疗类风湿性关节炎。当时的神经外科住院医师约瑟夫·加利奇（Joseph Galicich）将风湿病药物应用到了神经外科。他给接受开颅手术切除肿瘤的患者注射了剂量，结果发现他们的偏瘫有所改善，中线移位得到缓解，死亡率也有所下降。他主张进行临床试验，该药物成为神经外科的中流砥柱。随着神经肿瘤治疗发展到包括免疫疗法，地塞米松的免疫抑制作用正在成为一种不良作用。那么问题就变成了：如果历史上唯一使用过的药物可能不利于患者的肿瘤治疗，那么该如何治疗患者的症状呢？自发现以来，地塞米松在该领域一直保持着令人印象深刻的持久力，60 多年来一直作为治疗脑水肿的标准药物。然而，随着免疫疗法的出现，有必要进行研究来评估在现代神经肿瘤疗法的背景下治疗症状性水肿的方法。