Under what circumstances would you start steroids for a patient with a new brain tumor prior to biopsy or resection?

In my opinion, for all brain tumors regardless of type, steroids should be initiated if it is felt that perilesional edema is the predominant cause of presenting symptoms or the amount of perilesional edema is large enough to cause midline or trans-tentorial shift, even if asymptomatic.

Otherwise, f...

Agree. As a corollary, if lymphoma is suspected, do NOT use steroids before diagnostic confirmation unless there are severe symptoms or significant mass effect. If steroids are unavoidable, diagnostic confirmation should be pursued within days due to the lymphotoxic effects of steroids decreasing di...