Primary central nervous system lymphoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Surgical intervention is not recommended for the management of primary central nervous system lymphoma, because the tumors are often deeply seated and spread throughout the brain.

• Surgery does not play a role in the treatment of primary central nervous system lymphoma because the tumors are often spread throughout the brain and located deep within the brain.^[1]
• A surgery for stereotactic biopsy may be done to make a diagnosis.^[1]

• Surgical resection is usually ineffective because of the depth of the tumor.
• Treatment with irradiation and corticosteroids often only produces a partial response, but tumor recurs in more than 90% of patients.
• Median survival is 10 to 18 months in immunocompetent patients, and less in those with AIDS.
• The addition of IV methotrexate and citrovorum may extend survival to a median of 3.5 years. If radiation is added to methotrexate, median survival may increase beyond 4 years.
• Radiation is not recommended in conjunction with methotrexate because of increased risk of leukoencephalopathy and dementia in patients older than 60 years of age^[2]

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