OBJECTIVEPrimary central nervous system lymphoma (PCNSL) is a rare CNS tumor with a poor prognosis. It is usually diagnosed by needle biopsy and treated mainly with high-dose chemotherapy. Resection is currently not considered a standard treatment option. A possible prolonged survival after resection of PCNSL lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established.METHODSThe authors retrospectively searched their patient database for records of adult patients (≥ 18 years) who were diagnosed and treated for a solitary PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared with undergoing biopsy only.RESULTSA total of 113 patients with a solitary lesion of PCNSL were identified; 36 patients underwent resection, and 77 had a diagnostic stereotactic biopsy only. The statically significant preoperative risk factors included age ≥ 70 years (adjusted HR 9.61, 95% CI 2.42–38.11; p = 0.001), deep-seated lesions (adjusted HR 3.33, 95% CI 1.13–9.84; p = 0.030), and occipital location (adjusted HR 4.26, 95% CI 1.08–16.78; p = 0.039). Having a postoperative Karnofsky Performance Scale (KPS) score < 80 (adjusted HR 3.21, 95% CI 1.05–9.77; p = 0.040) and surgical site infection (adjusted HR 4.27, 95% CI 1.18–15.47; p = 0.027) were significant postoperative risk factors after the adjustment and selection by means of other possible risk factors. In a subgroup analysis, patients younger than 70 years who underwent resection had a nonsignificant trend toward longer survival than those who underwent needle biopsy (median survival 35.0 months vs 15.2 months, p = 0.149). However, patients with a superficial tumor who underwent resection had significantly longer survival times than those who underwent needle biopsy (median survival 34.3 months vs 8.9 months, p = 0.014). Patients younger than 70 years who had a superficial tumor and underwent resection had significantly prolonged survival, with a median survival of 35.0 months compared with 8.9 months in patients from the same group who underwent needle biopsy (p = 0.007).CONCLUSIONSSpecific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from resection compared with undergoing only a diagnostic biopsy.

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Occult spinal dysraphism (OSD) comprises different forms of failure in embryogenic development that can lead to genitourinary, spinal, or lower limb alterations, thus determining progressive neurological deterioration. The correct management of children harboring OSD represents a significant issue during their life up to adulthood. However, patients often have to entertain individual consultations with each specialist. We settled on a multidisciplinary team comprising pediatric neurosurgeons, urologists, neurologists, orthopedists, and other supporting physicians. We present the results of such actions by analyzing a series of 141 children with OSD subjected to neurosurgical procedures, evaluating the impact of multidisciplinary management on outcomes. We also evaluated the specific actions according to the different ages of OSD patients from birth to adulthood to provide a schematic plan that could represent a basis for establishing and disseminating the need for a multidisciplinary approach in OSD management. The multidisciplinary team allows all consultants to see the patient together, covering specific aspects of history and examination pertinent to their management. Offering a one-stop service prevents coordination issues between the different medical teams, avoids delays or cancellations of the various appointments, optimizes cost-effectiveness, and improves efficiency and parents’ satisfaction.

OBJECTIVE A possible prolonged survival after surgical resection for primary central nervous system lymphoma (PCNSL) lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established. METHODS We retrospectively searched our patient database for records of adult patients (≥18 years) who were diagnosed and treated for a solitary lesion of PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent surgical resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared to undergoing biopsy only. RESULTS 113 patients with a solitary lesion of PCNSL were identified, 36 underwent surgical resection and 77 a diagnostic stereotaxic biopsy only. Pre-operative risk factors were found to include age &gt; 70 years ([HR] 9.61, 95% [CI] 2.42-38.11, p=0.001) and deep seated lesions (adjusted HR 3.33, 95% CI 1.13-9.84, p=0.030). Having a postoperative Karnofsky Performance Scale (KPS) under 80 (adjusted HR 3.21, 95% CI 1.05-9.77, p=0.040) or surgical-site infections (adjusted HR 4.27, 95% CI 1.18-15.47, p=0.027) were significant postoperative risk factors. In a subgroup analysis, patients with a superficial tumor who underwent surgical resection had significantly longer survival times compared with those who underwent needle biopsy (median survival 34.3 months versus 8.9 months, p=0.014). Patients under 70 years who had a superficial tumor and underwent surgical resection had significantly prolonged survival, with a median survival of 35.0 months versus 8.9 months in patients from the same group who underwent needle biopsy (p=0.007). CONCLUSION Specific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from surgical resection compared to undergoing only a diagnostic biopsy.