Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review

  • Research
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Introduction

To date, confined intra-ventricular localization of primary central nervous system lymphoma (PCNSL) has been usually managed with open surgical resection and/or stereotactic biopsy; nonetheless, the endoscopic approach to such localization can provide many advantages over standard microsurgery and/or stereotactic biopsy. Here we present our experience in managing such a rare pathology through the endoscopic approach.

Method

In order to gather more information about such a rare pathology, a retrospective multicentric study on a prospectively built database has been performed during a 5 year period. Ten different European centers have been involved.

Results

A total of 60 patients, 25 women and 35 men, have been enrolled in the study. The mean age was 65.3 years. The mean lesion size was 40.3 mm. Among all selected patients, 40 (66.6%) had superficial lesions within the ventricle, whereas the remaining 20 (33.4%) had lesions involving/extending to deeper structures. All surgical procedures were uneventful and ETV was deemed necessary only in 20/60 cases.

Conclusion

In our experience, endoscopic management of intraventricular PCNSL is an effective option. It should be considered after a careful examination of neurological and immunological status, alternative options for diagnostic sampling, location of the lesion, and presence or absence of hydrocephalus. Endoscopic management could be considered as a safe and minimally invasive option to obtain: (a) a biopsy sample of the lesion for further diagnostic workup, (b) CSF diversion through third ventriculostomy or VP shunt for the management of hydrocephalus, and (c) insertion of ventricular access devices for long term medical management and whenever necessary as a rescue option for ventricular tap.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Haldorsen IS, Espeland A, Larsson EM (2011) Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol 32(6):984–992

    Article  CAS  Google Scholar 

  2. Hochberg FH, Baehring JM, Hochberg EP (2007) Primary CNS lymphoma. Nat Clin Pract Neurol 3(1):24–35

    Article  CAS  Google Scholar 

  3. Cecchi PC, Billio A, Colombetti V, Rizzo P, Ricci UM, Schwarz A (2008) Primary high-grade B-cell lymphoma of the choroid plexus. Clin Neurol Neurosurg 110(1):75–79

    Article  Google Scholar 

  4. Hassan HA, Ramli NM, Rahmat K (2012) Primary intraventricular lymphoma with diffuse leptomeningeal spread at presentation. Ann Acad Med Singap 41(6):268–270

    PubMed  Google Scholar 

  5. Park SW, Yoon SH, Cho KG (2006) An endoscopically proven ventriculitis-type, cyst-like intraventricular primary lymphoma of the central nervous system. Acta Neurochir 148(9):981–984

    Article  CAS  Google Scholar 

  6. Funaro K, Bailey KC, Aguila S, Agosti SJ, Vaillancourt C (2014) A case of intraventricular primary central nervous system lymphoma. J Radiol Case Rep 8(3):1–7

    PubMed  PubMed Central  Google Scholar 

  7. Lettau M, Laible M (2012) Primary intraventricular non-Hodgkin’s lymphoma of the CNS. Rofo 184(3):261–326

    Article  CAS  Google Scholar 

  8. Cheatle JT, Aizenberg MR, Weinberg JS, Surdell DL (2013) Atypical presentation of primary central nervous system non-Hodgkin lymphoma in immunocompetent young adults. World Neurosurg 79(3–4):593.e9–13

    Article  Google Scholar 

  9. Mallereau CH, Chibbaro S, Ganau M, Benmekhbi M, Cebula H, Dannhoff G, Santin MD, Ollivier I, Chaussemy D, Hugo Coca A, Proust F, Todeschi J (2022) Pushing the boundaries of accuracy and reliability during stereotactic procedures: a prospective study on 526 biopsies comparing the frameless robotic and image-guided surgery systems. J Clin Neurosci 95:203–212. https://doi.org/10.1016/j.jocn.2021.11.034.)

    Article  PubMed  Google Scholar 

  10. Bataille B, Delwail V, Menet E et al (2000) Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg 92:261–266

    Article  CAS  Google Scholar 

  11. Fraser E, Gruenberg K, Rubenstein JL (2015) New approaches in primary central nervous system lymphoma. Chin Clin Oncol 4(1):11. https://doi.org/10.3978/j.issn.2304-3865.2015.02.01.PMID:25841718;PMCID:PMC4942281

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chibbaro S, Cebula H, Scholly J, Todeschi J, Ollivier I, Timofeev A, Ganau M, Di Emidio P, Valenti MP, Staack AM, Bast T, Steinhoff BJ, Hirsch E, Kehrli P, Proust F (2017) Pure endoscopic management of epileptogenic hypothalamic hamartomas. Neurosurg Rev 40(4):647–653. https://doi.org/10.1007/s10143-017-0822-3 (Epub 2017 Feb 7 PMID: 28168619)

    Article  CAS  PubMed  Google Scholar 

  13. Cebula H, Chibbaro S, Santin MN, Kremer S, Chaussemy D, Proust F (2016) Thalamic rosette-forming a glioneuronal tumor in an elderly patient: Case report and literature review. Neurochirurgie 62(1):60–63. https://doi.org/10.1016/j.neuchi.2015.10.003 (Epub 2015 Dec 17 PMID: 26705911)

    Article  CAS  PubMed  Google Scholar 

  14. Chibbaro S, Di Rocco F, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A (2012) Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev. 35(3):331–38. https://doi.org/10.1007/s10143-011-0370-1

    Article  CAS  PubMed  Google Scholar 

  15. Romano A, Chibbaro S, Makiese O, Marsella M, Mainini P, Benericetti E (2009) Endoscopic removal of a central neurocytoma from the posterior third ventricle. J Clin Neurosci 16(2):312–316. https://doi.org/10.1016/j.jocn.2008.03.011 (Epub 2008 Dec 11 PMID: 19084413)

    Article  CAS  PubMed  Google Scholar 

  16. Chibbaro S, Champeaux C, Poczos P, Cardarelli M, Di Rocco F, Iaccarino C, Servadei F, Tigan L, Chaussemy D, George B, Froelich S, Kehrli P, Romano A (2014) Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study. Neurosurg Rev 37(2):235–41. https://doi.org/10.1007/s10143-013-0508-4

    Article  CAS  PubMed  Google Scholar 

  17. Aljohani H, Romano A, Iaccarino C, Ganau M, Diemidio P, Chibbaro S (2018) Pure endoscopic management of fourth ventricle arachnoid cyst: case report and literature review. Asian J Neurosurg. 13(1):184–187. https://doi.org/10.4103/1793-5482.180956

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gupta RK, Naran S, Lallu S, Fauck R (2004) Cytodiagnosis of neoplasms of the central nervous system in cerebrospinal fluid samples with an application of selective immunostains in differentiation. Cytopathology 15(1):38–43

    Article  CAS  Google Scholar 

  19. Bühring U, Herrlinger U, Krings T, Thiex R, Weller M, Küker W (2001) MRI features of primary central nervous system lymphomas at presentation. Neurology 57(3):393–396

    Article  Google Scholar 

  20. Go JL, Lee SC, Kim PE (2006) Imaging of primary central nervous system lymphoma. Neurosurg Focus 21(5):E4

    Article  Google Scholar 

  21. Da Silva AN, Lopes MB, Schiff D (2006) Rare pathological variants and presentations of primary central nervous system lymphomas. Neurosurg Focus 21(5):E7

    Article  Google Scholar 

  22. Maimone G, Ganau M, Nicassio N, Paterniti S (2013) Paratrigonal choroid plexus papilloma presenting with satellite multiple supra- and infratentorial hemorrhages. Neuroanatomical basis and pathological hypothesis. Int J Surg Case Rep 4(3):239–242

    Article  CAS  Google Scholar 

  23. Commins DL (2006) Pathology of primary central nervous system lymphoma. Neurosurg Focus 21(5):E2

    Article  Google Scholar 

  24. Chamberlain MC, Johnston SK (2009) Neoplastic meningitis: survival as a function of cerebrospinal fluid cytology. Cancer 115(9):1941–1946

    Article  Google Scholar 

  25. Hirato T, Komatsu K, Nishida N, Matsumoto S (2021) Intraventricular primary central nervous system lymphoma mimicking ventriculitis. Intern Med 60(11):1797–1798. https://doi.org/10.2169/internalmedicine.6174-20

    Article  PubMed  Google Scholar 

  26. Khanna G, Ahlawat S, Garg N, Gupta R, Patir R (2021) A rare case of isolated intraventricular primary central nervous system lymphoma in an 85-year-old man. Asian J Neurosurg 16(3):623–625. https://doi.org/10.4103/ajns.AJNS_551_20

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kumar H, Sharma A, Sharma V, Singhvi S (2020) Primary central nervous system lymphoma involving entire ventricular system. Asian J Neurosurg 15(1):126–127. https://doi.org/10.4103/ajns.AJNS_94_16

    Article  PubMed  PubMed Central  Google Scholar 

  28. Perez-Roman RJ, Hubbard ZS, Brusko GD, Starke RM (2020) A case of primary central nervous system lymphoma presenting as a shunt complication. Br J Neurosurg. https://doi.org/10.1080/02688697.2020.1735300

    Article  PubMed  Google Scholar 

  29. Ball MK, Morris JM, Wood AJ, Meyer FB, Kaszuba MC, Raghunathan A (2020) Ventricle-predominant primary CNS lymphomas: clinical, radiological and pathological evaluation of five cases and review of the literature. Brain Tumor Pathol 37(1):22–30. https://doi.org/10.1007/s10014-019-00354-x (Epub 2019 Oct 19 PMID: 31630277)

    Article  CAS  PubMed  Google Scholar 

  30. Wada-Shimosato Y, Ikeda J, Tsujimoto SI, Sasaki K, Yanagimachi M, Kajiwara R, Shiba N, Murata H, Kawahara N, Yamanaka S, Tanoshima R, Ito S (2019) Intraventricular rituximab in pediatric CD20-positive refractory primary central nervous system lymphoma. J Pediatr Hematol Oncol 41(7):571–573. https://doi.org/10.1097/MPH.0000000000001291 (PMID: 30124546)

    Article  CAS  PubMed  Google Scholar 

  31. Guo R, Zhang X, Niu C, Xi Y, Yin H, Lin H, Chang T (2019) Primary central nervous system small lymphocytic lymphoma in the bilateral ventricles: two case reports. BMC Neurol 19(1):200. https://doi.org/10.1186/s12883-019-1430-3.PMID:31426757;PMCID:PMC6699128

    Article  PubMed  PubMed Central  Google Scholar 

  32. Philippart M, Mulquin N, Gustin T, Fervaille C, London F (2019) Primary central nervous system lymphoma revealed by multiple intraventricular mass lesions. Acta Neurol Belg 119(1):119–121. https://doi.org/10.1007/s13760-018-1017-6 (Epub 2018 Sep 3 PMID: 30178179)

    Article  PubMed  Google Scholar 

  33. Brozovich A, Ewing D, Burns E, Hatcher C, Acosta G, Khan U, Chung B, Samuel L, Randhawa J, Pingali SR (2019) Primary CNS lymphoma arising from the 4th ventricle: a case report and review of the literature. Case Rep Oncol Med 10(2019):2671794. https://doi.org/10.1155/2019/2671794

    Article  Google Scholar 

  34. Hsu HI, Lai PH, Tseng HH, Hsu SS (2015) Primary solitary lymphoma of the fourth ventricle. Int J Surg Case Rep. 14:23–5. https://doi.org/10.1016/j.ijscr.2015.07.006

    Article  PubMed  PubMed Central  Google Scholar 

  35. Suri V, Mittapalli V, Kulshrestha M, Premlani K, Sogani SK, Suri K (2015) Primary intraventricular central nervous system lymphoma in an immunocompetent patient. J Pediatr Neurosci. 10(4):393–5. https://doi.org/10.4103/1817-1745.174433

    Article  PubMed  PubMed Central  Google Scholar 

  36. Grossman R, Nossek E, Shimony N, Raz M, Ram Z (2014) Intraoperative 5-aminolevulinic acid-induced fluorescence in primary central nervous system lymphoma. J Neurosurg 120(1):67–69. https://doi.org/10.3171/2013.9.JNS131076 (Epub 2013 Oct 18 PMID: 24138204)

    Article  PubMed  Google Scholar 

  37. Maka VV, Chitrapur R, Kilara N, Prabhu VM, Krishnamoorthy N (2015) Management of Hodgkin’s lymphoma with midbrain involvement: a case report and review of literature. Hematology 20(5):272–275. https://doi.org/10.1179/1607845414Y.0000000190 (Epub 2014 Aug 18 PMID: 25133862)

    Article  CAS  PubMed  Google Scholar 

  38. Zhu Y, Ye K, Zhan R, Tong Y (2015) Multifocal lateral and fourth ventricular primary central nervous system lymphoma: case report and literature review. Turk Neurosurg 25(3):493–495. https://doi.org/10.5137/1019-5149.JTN.10496-14.1 (PMID: 26037194)

    Article  PubMed  Google Scholar 

  39. Brar R, Prasad A, Sharma T, Vermani N (2012) Multifocal lateral and fourth ventricular B-cell primary CNS lymphoma. Clin Neurol Neurosurg 114(3):281–283. https://doi.org/10.1016/j.clineuro.2011.10.020 (Epub 2011 Nov 17 PMID: 22100106)

    Article  PubMed  Google Scholar 

  40. Hill CS, Khan AF, Bloom S, McCartney S, Choi D (2009) A rare case of vomiting: fourth ventricular B-cell lymphoma. J Neurooncol 93(2):261–262. https://doi.org/10.1007/s11060-008-9765-4 (Epub 2008 Dec 18 PMID: 19093074)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None

Funding

The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Oxford University Hospital, Oxford, UK

    Mario Ganau

  2. Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France

    Julien Todeschi, Helene Cebula, Beniamino Nannavecchia, Francois Proust & Salvatore Chibbaro

  3. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

    Laura Prisco

  4. Department of Neurosurgery, Bonomo Hospital Andria, Andria, Italy

    Carmen Bruno

  5. Department of Neurosurgery, Poliambulanza Hospital, Brescia, Italy

    Giorgio Spatola

  6. Department of Neurosurgery, Institute of Aerospace Medicine, Milan, Italy

    Gianfranco K. I. Ligarotti

  7. Department of Neurosurgery, Caltanissetta Hospital, Caltanissetta, Italy

    Raffaele Alessandrello

  8. Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy

    Marco Fricia

  9. Department of Neurosurgery, Modena University Hospital, Modena, Italy

    Antonio Romano

  10. Department of Neurosurgery, Neuro-Radiology Unit, Strasbourg University Hospital, Strasbourg, France

    Ismail Zaed, Raoul Pop & Seyyid Baloglu

  11. Department of Neurosurgery, Ospedale “Casa Sollievo Della Sofferenza”, San Giovanni Rotondo, Italy

    Luciano Savarese

  12. Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), University of Bologna, Neurosurgical Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna (ISNB), Bologna, Italy

    Antonino Scibilia

Authors
  1. Mario Ganau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ismail Zaed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julien Todeschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Prisco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helene Cebula
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carmen Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giorgio Spatola
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gianfranco K. I. Ligarotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Raffaele Alessandrello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marco Fricia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Antonio Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Raoul Pop
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Seyyid Baloglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Luciano Savarese
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Antonino Scibilia
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Beniamino Nannavecchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Francois Proust
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Salvatore Chibbaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: MG, IZ, SC. Acquisition of data: MG, IZ, CB, GS, GKIL, RA, MF, AR, LS, AS. Analysis and interpretation of data: IZ, MG, SC, JT. Drafting the article: All Authors. Critically revising the article: All authors.

Corresponding author

Correspondence to Ismail Zaed.

Ethics declarations

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Informed consent

All patients have given written consent for publication of this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ganau, M., Zaed, I., Todeschi, J. et al. Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review. J Neurooncol 159, 457–468 (2022). https://doi.org/10.1007/s11060-022-04081-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-022-04081-w

Keywords

Search

Navigation