European Survey on Neurosurgical Management of Primary Central Nervous System Lymphomas and Preoperative Corticosteroid Therapy

Overview

Journal Brain Spine

Specialty Neurology

Date 2023 Nov 29

PMID 38020980

Authors

Florian Scheichel

Branko Popadic

Daniel Pinggera

Dariusz J Jaskolski

Vincent Lubrano

Nicolas Foroglou

David Netuka

Bogdan Iliescu

Laszlo Novak

Camillo Sherif

Franz Marhold

Christian F Freyschlag

Affiliations

Soon will be listed here.

Abstract

Introduction: Preoperative corticosteroid therapy (CST) is common in primary central nervous system lymphoma (PCNSL) and may complicate histopathological diagnosis. There is an ongoing debate on the best management after preoperative CST.

Research Question: We aimed to survey how different European neurosurgical units treat PCNSL patients after preoperative CST.

Methods: An English-language survey consisting of 21 questions addressing the management of patients with suspected PCNSL and preoperative CST was sent to European hospitals. The survey also included three clinical cases to assess the decision-making process in a clinical setting.

Results: The survey was completed by 74 European hospitals. There was no clear consensus on how to treat a patient with PCNSL after CST. Accordingly, 24.3% responded that they would generally defer surgery regardless of a possible radiological response, 47.3% would defer surgery only if there is regression in preoperative MRI and the remaining 28.4% would defer surgery only if the tumor had completely vanished. Furthermore, there were distinct discrepancies in responses of neurosurgical units regarding their general management approach and their case-based decision in the three example cases. The results of our survey also showed regional differences and differences in treatment decisions between high-, intermediate- and low-volume centers.

Discussion And Conclusion: There was no clear consensus on how to treat patients with suspected PCNSL and preoperative CST. Furthermore, most centers also showed inconsistencies in their responses regarding their general approach as well as individual patient treatment. More high-quality evidence-based recommendations are needed to improve consensus and thus patient care.

Citing Articles

Deep learning aided preoperative diagnosis of primary central nervous system lymphoma.

Naser P, Maurer M, Fischer M, Karimian-Jazi K, Ben-Salah C, Bajwa A iScience. 2024; 27(2):109023.

PMID: 38352223 PMC: 10863328. DOI: 10.1016/j.isci.2024.109023.

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