Intraoperative hydrocortisone irrigation of the cerebrospinal fluid pathways may reduce symptoms attributed to aseptic meningitis, which often follow the resection of epidermoid spinal tumors. Here, 20 patients undergoing surgical resection of epidermoid tumors were randomly assigned to two groups: Group I received intraoperative hydrocortisone irrigation, whereas Group II served as a control. No patient receiving hydrocortisone experienced fevers or meningismus, but nontreated patients experienced fevers (100%) and meningismus (78%). Nausea and vomiting were reduced (9%) in the treated versus untreated groups (22% vs. 11%, respectively), whereas none in the treated group noted dizziness, vertigo, or diabetes insipidus. As steroid irrigation significantly decreased the perioperative morbidity of epidermoid tumor resection, indications for intravenous steroids may become more limited, thereby reducing cost.