TY - EJOU
AU - Altieri, Roberto
AU - Certo, Francesco
AU - Garozzo, Marco
AU - Cammarata, Giacomo
AU - Maione, Massimiliano
AU - Fiumanò, Giuseppa
AU - Broggi, Giuseppe
AU - Vecchio, Giada Maria
AU - Caltabiano, Rosario
AU - Magro, Gaetano
AU - Barbagallo, Giuseppe
TI - The Neurosurgical Challenge of Primary Central Nervous System Lymphoma Diagnosis: A Multimodal Intraoperative Imaging Approach to Overcome Frameless Neuronavigated Biopsy Sampling Errors
T2 - Oncologie
PY - 2022
VL - 24
IS - 4
SN - 1765-2839
AB - 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.
KW - Central nervous system lymphoma; diagnosis; imaging; neuronavigated biopsy
DO - 10.32604/oncologie.2022.025393