CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e167-e173
DOI: 10.1055/s-0041-1734013
Review Article

Oncotic (Myxomatous) Aneurysms: A Review of Management

Aneurismas oncóticos (mixomatosos): Revisão das opções de tratamento
1   Neurosurgery Service, Hospital Santa Julia, Manaus, AM, Brazil
2   Neuroradiology Service, Fundação Hospital do Coração Francisca Mendes, Manaus, AM, Brazil
,
1   Neurosurgery Service, Hospital Santa Julia, Manaus, AM, Brazil
2   Neuroradiology Service, Fundação Hospital do Coração Francisca Mendes, Manaus, AM, Brazil
,
3   Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
4   Sensumed Oncologia, Manaus, AM, Brazil
,
5   Clínica Prodimagem, Manaus, AM, Brazil
› Author Affiliations

Abstract

Atrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in ∼ 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

Resumo

Mixomas atriais são os tumores primários cardíacos mais comuns. Podem levar a manifestações neurológicas em cerca de 30% dos pacientes devido a: isquemia cerebral, formação de aneurismas e metástases extravasculares. Alterações perilesionais encontradas tanto nas de tomografia (TC) ou ressonância magnética (RM) podem ajudar no diagnóstico de aneurismas mixomatosos, que geralmente envolvem ramos distais das artérias cerebral média e posterior. Ressecção cirôrgica cuidadosa da lesão cardíaca é essencial para prevenção de eventos embólicos. Entretanto, por sua história natural mal conhecida devida à raridade da condição, o tratamento dos aneurismas mixomatosos é controverso, incluindo conduta conservadora em pacientes assintomáticos, abordagem cirôrgica, endovascular, quimioterapia adjuvante e radioterapia em baixas doses. Discutiremos dois casos clínicos de pacientes femininas com aneurismas mixomatosos, tendo o primeiro caso o acometimento neurológico como manifestação inicial e o segundo com sintomas posteriores ao tratamento cirôrgico do tumor primário. Determinação da melhor escolha do tratamento deve levar em consideração taxa de crescimento da lesão, sua topografia, morfologia e clínica do paciente. Mais estudos clínicos são necessários para melhor compreensão e definição de conduta desses pacientes.



Publication History

Received: 18 April 2021

Accepted: 30 July 2021

Article published online:
13 January 2022

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