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 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:
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.
Keywords
Cite This Article
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.