@Article{oncologie.2022.025393,
AUTHOR = {Roberto Altieri, Francesco Certo, Marco Garozzo, Giacomo Cammarata, Massimiliano Maione, Giuseppa Fiumanò, Giuseppe Broggi, Giada Maria Vecchio, Rosario Caltabiano, Gaetano Magro, Giuseppe Barbagallo},
TITLE = {The Neurosurgical Challenge of Primary Central Nervous System Lymphoma Diagnosis: A Multimodal Intraoperative Imaging Approach to Overcome Frameless Neuronavigated Biopsy Sampling Errors},
JOURNAL = {Oncologie},
VOLUME = {24},
YEAR = {2022},
NUMBER = {4},
PAGES = {693--706},
URL = {http://www.techscience.com/oncologie/v24n4/51006},
ISSN = {1765-2839},
ABSTRACT = {<b>Background: </b>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 <sup>11</sup>C-MET-PET) to overcome potential targeting errors secondary to
tumor volume reduction after corticosteroid therapy. <b>Materials and Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.},
DOI = {10.32604/oncologie.2022.025393}
}