Hemorrhagic Attitude in Frameless and Frame-Based Stereotactic Biopsy for Deep-Seated Primary CNS Lymphomas in Immunocompetent Patients: A Multi-Centric Analysis of the Last Twenty Years

Abstract: Background Primary Central Nervous System Lymphoma (PCNSL) is a rare manifestation of aggressive extranodal non-Hodgkin's lymphoma . In cases of deep-seated lesions stereotactic brain biopsy (SBB) is an accepted diagnostic procedure to obtain a histopathologic confirmation. Objective The aim of this study is to assess the feasibility, diagnostic yield, safety and complications of stereotactic procedures in midline and deep-seated PCNSLs Methods Patients selected had received a histopathologic diagnosis of PCNSL localized in deep-seated midline structures, obtained by SBB . The intraoperative frozen section was executed as an integral part of the procedure. CT scan was performed following surgery. Results 476 SBBs were performed between January 2000 and December 2019 . Of these, 91 deep seated lesions had a histologic diagnosis of PCNSL . A significant increase of the incidence of PCNSL compared to all other pathologies was observed (p Conclusions In suspected cases of PCNSL, a histopathologic diagnosis is necessary to distinguish it from GBM or other, non-malignant, conditions. Deep-seated PCNSLs present a higher risk of biopsy-related morbidity and mortality. Intraoperative frozen section increases the diagnostic yield and reduces the number of sampling procedures. Post operative CT scan appears to be warranted in cases of suspected PCNSL.