Open Access iconOpen Access

ARTICLE

crossmark

The Neurosurgical Challenge of Primary Central Nervous System Lymphoma Diagnosis: A Multimodal Intraoperative Imaging Approach to Overcome Frameless Neuronavigated Biopsy Sampling Errors

Roberto Altieri1,2,*, Francesco Certo1, Marco Garozzo1, Giacomo Cammarata1, Massimiliano Maione1, Giuseppa Fiumanò3, Giuseppe Broggi4, Giada Maria Vecchio4, Rosario Caltabiano4, Gaetano Magro4, Giuseppe Barbagallo1

1 Division of Neurosurgery, Department of Neurosciences, Policlinico “G. Rodolico-S. Marco”, University Hospital, Catania, 95123, Italy
2 PhD Program at Department of Neuroscience, University of Turin, Turin, 10100, Italy
3 Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Catania, 95123, Italy
4 Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, Catania, 95123, Italy

* Corresponding Author: Roberto Altieri. Email: email

Oncologie 2022, 24(4), 693-706. https://doi.org/10.32604/oncologie.2022.025393

Abstract

Background: Intracranial lymphoma remains a challenging differential diagnosis in daily neurosurgical practice. We analyzed our early experience with a surgical series of frameless neuronavigated biopsies in Primary CNS Lymphomas (PCNSLs), highlighting the importance of using an intraoperative combined imaging protocol (5-ALA fluorescence, i-CT and 11C-MET-PET) to overcome potential targeting errors secondary to tumor volume reduction after corticosteroid therapy. Materials and Methods: All patients treated for PCNLSs at our center in a 24-month period (1/1/2019 to 31/12/2020) were analyzed. Our cohort included 6 patients (4 males), with a median age of 67 years (59–82). A total of 45 samples were evaluated for correlation between intraoperative fluorescence and pathological findings. 39 samples biopsy were evaluated. Results: 54% samples showed a clear diagnosis of PCNSL. 64% of samples had a lava like fluorescence. i-CT scan showed tumor volume changes, in comparison to preoperative MRI, in all cases and helped in planning correct trajectories on updated imaging; after biopsy i-CT confirmed sampling accuracy and excluded procedural complications in all cases. Conclusions: We believe that the use of a multimodal intraoperative imaging approach overcomes the demonstrated PCNSL morphological changes caused by corticosteroid therapy and gives a reliable tissue diagnosis by frameless biopsy.

Keywords


Cite This Article

APA Style
Altieri, R., Certo, F., Garozzo, M., Cammarata, G., Maione, M. et al. (2022). The neurosurgical challenge of primary central nervous system lymphoma diagnosis: A multimodal intraoperative imaging approach to overcome frameless neuronavigated biopsy sampling errors. Oncologie, 24(4), 693-706. https://doi.org/10.32604/oncologie.2022.025393
Vancouver Style
Altieri R, Certo F, Garozzo M, Cammarata G, Maione M, Fiumanò G, et al. The neurosurgical challenge of primary central nervous system lymphoma diagnosis: A multimodal intraoperative imaging approach to overcome frameless neuronavigated biopsy sampling errors. Oncologie . 2022;24(4):693-706 https://doi.org/10.32604/oncologie.2022.025393
IEEE Style
R. Altieri et al., "The Neurosurgical Challenge of Primary Central Nervous System Lymphoma Diagnosis: A Multimodal Intraoperative Imaging Approach to Overcome Frameless Neuronavigated Biopsy Sampling Errors," Oncologie , vol. 24, no. 4, pp. 693-706. 2022. https://doi.org/10.32604/oncologie.2022.025393



cc This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
  • 1396

    View

  • 734

    Download

  • 0

    Like

Share Link