Open Access

ARTICLE

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

Roberto Altieri^1,2,*, 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:

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

Received 08 August 2022; Accepted 30 September 2022; Issue published 31 December 2022

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.

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