Coil embolization of an enlarging fusiform myxomatous cerebral aneurysm

Abstract

Myxomatous cerebral aneurysms are rare sequelae of cardiac atrial myxoma. These aneurysms are generally fusiform, multiple, and distal. Pathogenesis and evolution of these aneurysms is still debated. There are currently no guidelines on the management of aneurysms secondary to atrial myxoma. We present a case of a 52-year-old man with multiple fusiform aneurysms 3 years after resection of a left atrial myxoma. One of these aneurysms was followed with cerebral angiography and showed substantial interval enlargement. This aneurysm was subsequently embolized. All aneurysms were stable 6 months post-embolization.

Multiple fusiform cerebral aneurysms detected after atrial myxoma resection: a report of two cases

“…However, too few cases have been described so far to be able to accurately determine the pathogenesis of this relationship. Myxomatous aneurysms are often distal in location, fusiform, and multiple, which limits treatment options such as coil embolisation or clipping [3]. We present two cases of multiple fusiform cerebral aneurysms detected several years after a heart myxoma resection.…”

“…The association between intracranial aneurysms and left atrial myxoma is known but rare [1,2]. Only 50 cases of a cerebral aneurysm following an atrial myxoma have been described since the first reported case in 1966 [3]. The pathogenesis of myxomatous aneurysms is still unclear.…”

“…Another hypothesis is that tumour emboli occlude the vessel lumen, causing scarring and pseudoaneurysm formation. Yet another thesis is that the embolised myxoma tissue blocks the vasa vasorum of the intracranial arteries, predisposing to weakening of the vessel wall and subsequent dilatation [3,4]. However, too few cases have been described so far to be able to accurately determine the pathogenesis of this relationship.…”

Delayed intracranial aneurysm formation after cardiac myxoma resection: Report of two cases and review of the literature

“…6,36 There are a few reported cases in the literature of patients with myxomatous aneurysms, of which all or a few disappeared after cardiac myxoma resection. 3,23,33,37,38 Our study provides the longest clinical and radiological followup evaluation of multiple myxomatous aneurysms and demonstrated that these lesions remain stable over time.…”

“…[15][16][17] Intracranial aneurysms are also found in the setting of new neurological deficits caused by recurrent cardiac myxoma 7,18,19 and rarely as a delayed presentation after complete cardiac myxoma resection. 7,[20][21][22][23][24][25][26][27][28][29][30] Cardiac myxoma surgery is the first choice procedure as this minimizes the risk of embolism from tumor material, but cannot completely abolished the risk of delayed intracranial aneurysm formation, presumably as a result of metastatic seeding into the cerebral vessels prior to surgery. 13 The time course of delayed aneurysm formation and detection is variable, probably related to the growing behavior of the myxomatous tissue.…”