Turkish Neurosurgery 2024 , Vol 34 , Num 3
Resection or Biopsy: The Efficacy of Different Surgical Approaches for Primary Central Nervous System Lymphoma
Yukun ZHANG1,Zongyue WANG2,Dongdong WANG3, Bo YU3,Jinkun WEN3,Shiwei HE1,Wei ZENG4,Cunzu WANG3
1Luoyang Central Hospital Affiliated to Zhengzhou University, Department of Neurosurgery, Luoyang, China
2Northern Jiangsu People?s Hospital Affiliated to Yangzhou University, Department of Medical Research Centre, Yangzhou, China
3Northern Jiangsu People?s Hospital Affiliated to Yangzhou University, Department of Neurosurgery, Yangzhou, China
4Yangzhou University, Yangzhou, China
DOI : 10.5137/1019-5149.JTN.41647-22.1 AIM: To analyze the efficacy of surgical resection versus brain biopsy combined with postoperative chemotherapy for primary central nervous system lymphoma (PCNSL) and to discuss a clinically standardized treatment protocol.

MATERIAL and METHODS: Patients with a pathological diagnosis of PCNSL and subsequent chemotherapy between 2016 and 2021 at Northern Jiangsu People?s Hospital were selected and divided into groups according to whether they underwent microsurgical resection or stereotactic needle biopsy. Statistical analyses were performed to compare efficacy and safety in the two groups.

RESULTS: A total of 21 patients with PCNSL were identified, of whom 12 underwent resection and 9 underwent diagnostic stereotactic biopsy only. Compared with the resection group, the biopsy group had a higher proportion of deep tumors (55.6% vs. 8.3%, p=0.016), and the mean intraoperative bleeding was significantly reduced (13.33 ± 6.61 mL vs. 170.83 ± 101.04 ml, p<0.001). In addition, the mean survival time of patients who died during the postoperative follow-up period was shorter (6.83 ± 1.60 vs. 18.56 ± 10.20 months, p=0.016), and the one-year survival rate was lower (33.3% vs. 83.3%, p=0.032). There was no significant difference between the two groups in terms of the mean progression-free survival time or new functional impairment after surgery.

CONCLUSION: For PCNSL, patients who undergo surgical resection have a better outcome than those who undergo biopsy only, suggesting that when the tumor is located at a surgically resectable site, surgical resection should be actively chosen; when the tumor is located at a deep and unresectable site, brain biopsy should be chosen. Keywords : Primary central nervous system lymphoma, Stereotactic biopsy, Surgical resection, Chemotherapy

Corresponding author : Cunzu WANG, neurosurgeonwang@126.com