title: [Avascular necrosis of the femoral head caused by steroid treatment in neurosurgery].
abstract: Steroid induced avascular necrosis of the femoral head is a well known disease, but, there are few reports about the disease in neurosurgical patients. In the neurosurgical field, the use of steroids has become prevalent since the 1960's. Recently, the adverse effect of steroids and the limitation of its effect have been highlighted, but its use against neurosurgical diseases is still a common treatment to prevent cerebral edema or to counteract hypo-pituitarism caused by hypophyseal lesions. We reviewed 250 patients of avascular necrosis treated between 1985 and 1997 in our institute. Within these patients, 11 (4.4%) were treated with steroid during neurosurgical treatment. Six patients were treated for brain tumors near hypophyseal lesions, and 5 patients were treated for head injury or cerebro-vascular disease. It is concluded that total steroid dose over 5000 mg such as hydrocortisone may become a high risk for causing avascular necrosis of the femoral had in neurosurgical disease, and it may occur even with the supplemental steroid treatment against hypo-pituitarism. The onset is usually 2 or 3 years after the neurosurgical treatment, when neurosurgical care is no longer needed. Therefore, it tends to be ignored in the neurosurgical field. The treatments against avascular necrosis of the femoral head were femoral head osteotomy or conservative management, and good results were obtained. Early diagnosis and early treatment is essential. Further consideration concerning steroid treatment in neurosurgical patients may be required.
authors.affiliation: Department of Neurosurgery, Fujigaoka Hospital, Showa University, Kanagawa-ken, Japan.
authors.forename: G
authors.initials: G
authors.lastname: Nagashima
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: J
authors.initials: J
authors.lastname: Asai
authors.forename: T
authors.initials: T
authors.lastname: Fujimoto
authors.forename: T
authors.initials: T
authors.lastname: Atsumi
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D005270:Femur Head / Q000601:surgery; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects*; D019635:Neurosurgical Procedures; D010027:Osteotomy
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone