Brain metastases and multiple cerebral aneurysms from cardiac myxoma: case report and review of the literature

Abstract

Cardiac myxoma, the most common benign cardiac tumour, can determine brain metastases or multiple cerebral aneurysms, but very few cases of both complications have been reported. We discuss the therapeutic management in the case of a patient, operated for a cardiac myxoma, who presented three intracerebral tumours and five cerebral microaneurysms.

Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

“…Myxomatous aneurysms, intracranial aneurysms associated with cardiac myxoma, are less common; their true incidence is unknown, but reports of such aneurysms are increasing with improvements in cardiac and neurovascular imaging that facilitate early detection of disease 8) . The mechanism for the formation of intracranial aneurysms in conjunction with cardiac myxomas is not well-established, but some hypotheses have been proposed: (1) Myxomatous emboli can block the vasa vasorum, destroying the normal architecture of the vessel, similar to mechanism of mycotic aneurysms; the vessel wall becomes vulnerable to ischemic injury and subsequent dilatation, which lead to aneurysm formation 2,8) ; (2) Myxomatous emboli produce vascular occlusion, causing scarring and pseudoaneurysm formation; (3) Tumor cells can proliferate and penetrate the wall; either mechanism can lead to scarring of the vessel wall and pseudoaneurysm formation 11,13) . The angiographic characteristics of myxomatous aneurysms are multiplicity, fusiform appearance, and distal location.…”

“Metastatic” embolic lesions and enlarging pseudoaneurysms associated with cardiac myxoma

“…Persistent lesions following myxoma resection have at times been attributed to intraoperative tissue manipulation with embolism or malignant transformation. 4 On MRI there are multiple foci of heterogeneous T1 and T2 signal intensity with blooming artifact on gradient-recalled echo, T2*-weighted, and susceptibility-weighted imaging sequences. These features may be explained by the accumulation of degradation products due to chronic recurrent hemorrhage and/or the proteinaceous myxoid matrix produced by the tumor.…”

“…7 Surgical removal of parenchymal lesions is suggested in cases of an isolated lesion with easy surgical access, symptomatic intracranial bleeding or mass effect, or when no clear diagnosis is available. 3,4,7 Due to the number of lesions and their friable nature, microsurgical clipping of pseudoaneurysms is of unclear benefit and not without risks. 3,7 In case of pseudoaneurysm rupture, surgical evacuation of the hematoma with clip ligation of the lesions has been described.…”

Intracranial Metastases

“…Multiple metastatic lesions are seen in 60-75% of all cases as determined by gadolinium-enhanced magnetic resonance imaging (MRI). 6 Systemic malignancies can metastasize into meningiomas. Metastases typically have surrounding vasogenic edema, although this rule is routinely broken in smaller lesions.…”