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Accuracy and safety of 101 consecutives neurosurgical procedures for newly diagnosed central nervous system lymphomas: a single-institution experience

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Abstract

Introduction

Brain surgery is required to ascertain the diagnosis of central nervous system lymphoma. We assessed the diagnostic yield and safety of the surgical procedures, the predictors of postoperative morbidity, and of overall survival.

Methods

Observational single-institution retrospective cohort study (1992–2020) of 101 consecutive adult patients who underwent stereotactic biopsy, open biopsy, or resection for a newly diagnosed central nervous system lymphoma.

Results

The diagnostic yield was 100% despite preoperative steroid administration in 48/101 cases (47.5%). A preoperative Karnofsky Performance Status score less than 70 (p = 0.006) was an independent predictor of a new postoperative focal neurological deficit (7/101 cases, 6.9%). A previous history of hematological malignancy (p = 0.049), age 65 years or more (p = 0.031), and new postoperative neurological deficit (p < 0.001) were independent predictors of a Karnofsky Performance Status score decrease 20 points or more postoperatively (13/101 cases, 12.9%). A previous history of hematological malignancy (p = 0.034), and preoperative Karnofsky Performance Status score less than 70 (p = 0.024) were independent predictors of postoperative hemorrhage (13/101 cases, 12.9%). A preoperative Karnofsky Performance Status score less than 70 (p = 0.019), and a previous history of hematological malignancy (p = 0.014) were independent predictors of death during hospital stay (8/101 cases, 7.9%). In the 82 immunocompetent patients harboring a primary central nervous system lymphoma, age 65 years or more (p = 0.044), and time to hematological treatment more than 21 days (p = 0.008), were independent predictors of a shorter overall survival. A dedicated hematological treatment (p < 0.001) was an independent predictor of a longer overall survival.

Conclusion

Brain biopsy is feasible with low morbidity for central nervous system lymphomas. Postoperatively, patients should be promptly referred for hematological treatment initiation.

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The authors have not disclosed any funding.

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Author notes

  1. Marc Zanello and Johan Pallud have participated equally.

Authors and Affiliations

  1. Department of Neurosurgery, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 1 rue Cabanis, 75014, Paris Cedex 14, France

    Ilyes Aliouat, Alessandro Moiraghi, Giorgia Antonia Simboli, Angela Elia, Alexandre Roux, Edouard Dezamis, Eduardo Parraga, Chiara Benevello, Marc Zanello & Johan Pallud

  2. Institute of Psychiatry and Neuroscience of Paris, IMABRAIN, INSERM U1266, Université de Paris, F-75014, Paris, France

    Ilyes Aliouat, Alessandro Moiraghi, Giorgia Antonia Simboli, Angela Elia, Alexandre Roux, Chiara Benevello, Corentin Provost, Catherine Oppenheim, Marc Zanello & Johan Pallud

  3. Hematology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France

    Rudy Birsen, Jérôme Tamburini & Didier Bouscary

  4. Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Angela Elia

  5. Pathology Department, Cochin Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France

    Diane Damotte

  6. Department of Neuroradiology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 75014, Paris, France

    Corentin Provost & Catherine Oppenheim

  7. Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 75014, Paris, France

    Fabrice Chretien

Authors
  1. Ilyes Aliouat
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Contributions

IA, AM, MZ, and JP did the data collection. IA, RB, MZ, and JP did the data analysis. IA, AM, GAS, RB, AE, AR, JT, ED, EP, CB, DD, CP, CO, DB, FC, MZ, and JP did the data interpretation. IA, GAS, MZ, and JP wrote the report. IA, AM, GAS, RB, AE, AR, JT, ED, EP, CB, DD, CP, CO, DB, FC, MZ, and JP reviewed and approved the paper.

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Correspondence to Johan Pallud.

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Aliouat, I., Moiraghi, A., Simboli, G.A. et al. Accuracy and safety of 101 consecutives neurosurgical procedures for newly diagnosed central nervous system lymphomas: a single-institution experience. J Neurooncol 159, 347–358 (2022). https://doi.org/10.1007/s11060-022-04069-6

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