Penn David L, Lanpher Arianna B, Klein Jennifer M, Kozakewich Harry P W, Kahle Kristopher T, Smith Edward R, Orbach Darren B
Departments of1Neurosurgery.
2Pathology, and.
J Neurosurg Pediatr. 2018 Mar;21(3):315-321. doi: 10.3171/2017.9.PEDS17288. Epub 2018 Jan 5.
The most common primary cardiac tumor is myxoma, typically originating in the left atrium. Emboli to the central nervous system can cause cerebral infarction or, rarely, seed tumor growth within vessel walls, causing myxomatous aneurysms. Fewer than 60 myxomatous aneurysms have been reported, including 2 cases in children. Here, the authors describe 2 different growing myxomatous aneurysms in a child successfully managed using a combined multidisciplinary approach. A 12-year-old boy developed a sudden headache, diplopia, gait instability, and speech difficulty. Magnetic resonance imaging revealed a left parietal hemorrhage and multifocal cerebral infarction, suspicious for an embolic etiology. A cardiac myxoma was identified in the left atrium and resected. Follow-up cranial vasculature imaging demonstrated multiple intracranial myxomatous aneurysms. These lesions were followed up, and serial imaging identified marked growth of 2 of them (right occipital and left parietal), prompting invasive intervention. The deep occipital lesion was better suited to endovascular treatment, while the superficial parietal lesion was amenable to resection. The patient underwent embolization of an enlarging fusiform aneurysm of the distal right posterior cerebral artery, followed by a left parietal craniotomy for a lesion of the distal left middle cerebral artery. Both procedures were performed without complications and achieved successful obliteration of the lesions, as confirmed by catheter angiography at the 30-month follow-up. To the authors' knowledge, this report illustrates the first combined endovascular and open surgical treatment of 2 myxomatous aneurysms in a single patient. While acknowledging the rarity of this condition, this report illustrates the clinical manifestations and treatment challenges posed by myxoma and details a successful strategy that could be employed in similar scenarios.
最常见的原发性心脏肿瘤是黏液瘤，通常起源于左心房。中枢神经系统栓塞可导致脑梗死，或很少见地在血管壁内播散肿瘤生长，形成黏液瘤性动脉瘤。报道的黏液瘤性动脉瘤少于60例，其中包括2例儿童病例。在此，作者描述了一名儿童中2种不同生长类型的黏液瘤性动脉瘤，采用多学科联合方法成功进行了治疗。一名12岁男孩出现突发头痛、复视、步态不稳和言语困难。磁共振成像显示左侧顶叶出血和多灶性脑梗死，怀疑为栓塞病因。在左心房发现了一个心脏黏液瘤并进行了切除。随访的颅脑血管成像显示多个颅内黏液瘤性动脉瘤。对这些病变进行了随访，系列成像发现其中2个（右枕叶和左顶叶）有明显生长，促使进行侵入性干预。枕叶深部病变更适合血管内治疗，而顶叶浅表病变适合切除。患者先接受了右侧大脑后动脉远端梭形动脉瘤的栓塞治疗，随后接受了左侧顶叶开颅手术以处理左侧大脑中动脉远端的病变。两个手术均无并发症，病变成功闭塞，30个月随访时的导管血管造影证实了这一点。据作者所知，本报告阐述了首例对单一患者的2个黏液瘤性动脉瘤进行血管内和开放手术联合治疗的病例。在承认这种情况罕见的同时，本报告阐述了黏液瘤的临床表现和治疗挑战，并详细介绍了在类似情况下可采用的成功策略。
