ERRATA

Primary Central Nervous System Lymphoma (PCNSL) is a rare and aggressive form of extranodal non-Hodgkin lymphoma confined to the central nervous system, accounting for less than 5% of all primary brain tumors. Historically, the role of surgery in the management of PCNSL has been limited to diagnostic biopsies due to the tumor’s responsiveness to high-dose methotrexate-based chemotherapy and its diffuse, infiltrative nature. However, recent advancements in neurosurgical techniques and growing interest in personalized, multimodal treatment approaches have led to renewed exploration of surgery's role in PCNSL. This review provides an in-depth analysis of the evolving role of surgery in PCNSL, focusing on modern indications, patient selection, and the integration of surgery with chemotherapy, radiotherapy, and molecular therapies. While chemotherapy remains the cornerstone of treatment, surgery may offer significant benefits in specific cases, such as for solitary, well-circumscribed lesions or life-threatening mass effects where resection can alleviate elevated intracranial pressure. In rare cases, open craniotomy may be required to obtain a more definitive diagnosis when non-invasive imaging proves inconclusive. Technological advancements, including stereotactic biopsy, endoscopic surgery, and fluorescence-guided surgery (FGS), have enhanced the precision and safety of surgical interventions in PCNSL, allowing for safer resection in cases where surgery is necessary, such as in solitary tumors causing significant neurological deficits. Moreover, the integration of surgery with high-dose methotrexate chemotherapy, targeted radiotherapy, and emerging molecular and genetic profiling offers a promising multimodal treatment strategy for select patients. The review highlights the potential for cytoreductive surgery to improve chemotherapy efficacy by reducing tumor burden, facilitating drug delivery, and improving local control when combined with stereotactic radiosurgery. Recent research into molecular markers, such as MYD88 mutations, provides insight into patient-specific surgical outcomes and prognoses, paving the way for personalized neurosurgical approaches. While gross total resection (GTR) may improve progression-free survival in selected cases, overall survival remains dependent on various factors, including response to chemotherapy and molecular profiles. In conclusion, while surgery is unlikely to replace chemotherapy as the primary treatment for PCNSL, it can play a valuable role in specific cases when integrated with other therapies. Continued research into patient selection, surgical techniques, and personalized treatment approaches will further refine the role of surgery in the evolving landscape of PCNSL management.