Objective To provide reference for the development of standard treatment protocols for primary central nervous system lymphomas (PCNSL) for Chinese neurosurgeons by performing an analysis of treatment status of PCNSL at Beijing Tiantan Hospital.Methods We retrospectively reviewed 65 patients with histologically proven PCNSL who were treated with high-dose methotrexate (MTX) from January 2006 to May 2013 at Beijing Tiantan Hospital, and compared them with PCNSL patients who received surgical resection alone or in combination with whole brain radiotherapy from 2004 to 2005 at the same hospital in terms of median overall survival, progression-free survival, and adverse reactions.Results After 4 to 7 cycles of chemotherapy with MTX, the overall response rate of the 65 cases of PCNSL was 89.2% [complete response (CR) 61.5%, partial response (PR) 27.7%]. The median overall survival for the cohort was 60.6 months and the progression-free survival was 39 months. The main adverse reactions induced by chemotherapy with methotrexate were oral ulcer, rash, nausea, vomiting, and thrombocytopenia. The median overall survival was 3.8 months in 14 patients with gross total resection or subtotal resection, and 14 months in 13 patients with gross total resection or subtotal resection followed by whole brain radiotherapy (P<0.01).Conclusions Complete resection or subtotal resection alone does not provide survival benefit for patients with PCNSL. High-dose MTX can improve survival and is still the first-line treatment for PCNSL.