The Role of Surgery in Primary Central Nervous System Lymphomas (PCNSL)

Abstract Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma confined to the CNS, historically treated with chemotherapy and radiotherapy. Surgery has primarily been limited to biopsy due to the tumor's diffuse nature and sensitivity to chemotherapy. However, recent advancements in neurosurgical techniques have prompted reevaluation of the role of surgery. Select patients with solitary, well-circumscribed lesions or life-threatening mass effects may benefit from surgical intervention. Advances such as minimally invasive techniques, neuronavigation, and fluorescence-guided surgery have enhanced the safety and precision of resections. Integrating surgery with chemotherapy or radiotherapy may improve local control and patient outcomes. Molecular profiling and personalized treatment strategies are being investigated to further refine the role of surgery in PCNSL management. While surgery is not yet a primary treatment, its evolving role offers potential benefits in carefully selected cases.