Abstract: Postoperative cognitive dysfunction (POCD) is a common complication of anesthesia and surgery. With advances in neurocognitive science, POCD has been classified under the category of perioperative neurocognitive disorders (PND). However its diagnostic criteria have not been standardized. Patients undergoing neurosurgery often have pre-existing  mild cognitive impairment. Moreover cognitive impairment can be directly exacerbated by structural and functional brain damage resulting from surgical procedures, which is significantly different from other surgical procedures. Dexamethasone, a commonly used neurosurgical agent, exerts neuroprotective effects through anti-inflammation, reduction of cerebral edema, and lowering of intracranial pressure. While some studies have indicated dexamethasone’s potential to mitigate POCD in non-neurosurgical settings, its performance and underlying mechanisms in neurosurgical procedures remain unclear. After a systematic search, only one randomized controlled trial for microvascular decompression was identified that directly addressed this issue. This article  aims to address the research gap concerning the relationship between dexamethasone and POCD in neurosurgery procedures to provide  insights  and implication for future investigations.

Key words: dexamethasone, glucocorticoid, neurosurgery, postoperative cognitive dysfunction, perioperative neurocognitive disorders, cognitive changes