Neurosurgery 99:30–39, 2026
This retrospective cohort study evaluates whether preoperative corticosteroid therapy (CST) affects the diagnostic yield of stereotactic brain biopsy (SBB) in 104 patients with pathologically confirmed primary central nervous system lymphoma (PCNSL). The analysis stratifies patients by steroid timing, duration, and cumulative dexamethasone-equivalent dose, reporting diagnostic rates, radiographic features, and complications.
Results show a 92.3% overall diagnostic yield that remained high regardless of CST exposure, dose, or timing, with comparable postoperative complication rates. The authors conclude short-course CST for symptom control appears safe before SBB, while emphasizing multidisciplinary coordination and need for prospective standardized protocols.
Clinical question Whether preoperative corticosteroid therapy (CST) (timing, dose, duration) reduces stereotactic brain biopsy (SBB) diagnostic yield in suspected primary CNS lymphoma (PCNSL), and whether it affects postoperative complications
Cohort & design Retrospective review of 725 SBBs (2014–2025) identifying 104 pathologically confirmed PCNSL cases; CST-naive vs CST-exposed with stratification by last-dose timing, cumulative dexamethasone-equivalent dose, and duration
Overall yield Initial SBB diagnostic yield for PCNSL was 92.3% (96/104), with 8 nondiagnostic initial biopsies
CST vs no CST yield Diagnostic yield was 95.3% with CST (41/43) vs 90.2% without CST (55/61), not significant (P = .46)
Timing of last CST dose Yield remained high across intervals: ≤48 h 96.4%, 48–72 h 91.7%, >72 h 100% (P = .66)
Cumulative dose & duration Yield did not differ by cumulative dexamethasone dose (≤20 mg 95.5%, 21–40 mg 100%, >40 mg 100%, P = 1.0) or by duration (≤5 days 94.6% vs >5 days 100%, P = 1.0)
Complications Postoperative complications occurred in 4.8% of PCNSL cases, with no significant difference between CST-exposed and CST-naive patients (P = .84)
Nondiagnostic biopsies & next steps Only 2/8 initially nondiagnostic cases had prebiopsy CST; all 8 were ultimately confirmed PCNSL via repeat SBB, CSF cytology, or postmortem, supporting repeat/alternative diagnostic approaches when initial biopsy is nondiagnostic