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

Background: Intracranial lymphoma remains a challenging differential diagnosis in daily neurosurgical practice. We analyzed our early experience with surgical series of frameless neuronavigated biopsies Primary CNS Lymphomas (PCNSLs), highlighting the importance using an intraoperative combined imaging protocol (5-ALA fluorescence, i-CT and 11C-MET-PET) to overcome potential targeting errors secondary tumor volume reduction after corticosteroid therapy. Materials methods: All patients treated for PCNLSs at center 24-month period (1/1/2019 31/12/2020) were analyzed. Our cohort included 6 (4 males), median age 67 years (59–82). A total 45 samples evaluated correlation between fluorescence pathological findings. 39 biopsy evaluated. Results: 54% showed clear PCNSL. 64% had lava like fluorescence. scan changes, comparison preoperative MRI, all cases helped planning correct trajectories on updated imaging; confirmed sampling accuracy excluded procedural complications cases. Conclusions: believe that use multimodal approach overcomes demonstrated PCNSL morphological changes caused by therapy gives reliable tissue biopsy.