Ghodasara Sagar Amrutlal, Balasubramanian Rohit, Varadharajan Shriram, Shobhanaa P S
Department of Neurosurgery, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India.
Department of Neuro-Imaging and Stroke Interventions, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India.
Surg Neurol Int. 2020 Nov 11;11:383. doi: 10.25259/SNI_410_2020. eCollection 2020.
Cardiac myxomas are sporadic in nature and can often recur with a frequency of 3%, especially in middle-aged women, and 22% of the cases account to a part of Carney complex. Complete surgical removal of the myxoma is usually curative. Recurrence has been related with partial surgical excision, multicentricity, and embolism of tumor fragments.
We report a case of a patient with single brain metastases due to tumor embolization, from a cardiac myxoma operated prior. This case is exclusive, as tumor embolization from atrial myxoma to the cerebral cortex can be possible, within a short duration. In our case, the patient was evaluated with a magnetic resonance imaging brain and a solitary hemorrhagic lesion in the eloquent cerebral cortex was observed. To determine the primary etiology, the diagnosis of probable metastases was thought of, and a thorough workup was planned. Surprisingly, no primary lesion was detected, and as a histological diagnosis was required, he underwent a navigation-guided excisional biopsy of lesion. The biopsy was indicative of a metastatic deposit from an atrial myxoma.
In eloquent cortex lesions, gross total resection is challenging for a neurosurgeon especially when the patient has no significant neurological deficits. Timely gross total resection of a solitary metastatic lesion can improve the patient's outcome and can enhance early recovery with less or no morbidity.
心脏黏液瘤本质上是散发性的，常以3%的频率复发，尤其在中年女性中，并且22%的病例属于卡尼综合征的一部分。黏液瘤的完整手术切除通常可治愈。复发与手术部分切除、多中心性以及肿瘤碎片栓塞有关。
我们报告一例患者，因先前手术的心脏黏液瘤发生肿瘤栓塞导致单发脑转移。该病例较为独特，因为心房黏液瘤在短时间内有可能栓塞至大脑皮质。在我们的病例中，患者接受了脑部磁共振成像检查，发现优势大脑皮质有一个孤立的出血性病变。为确定原发性病因，考虑了可能的转移瘤诊断，并计划进行全面检查。令人惊讶的是，未检测到原发性病变，由于需要组织学诊断，患者接受了导航引导下的病变切除活检。活检结果显示为心房黏液瘤的转移灶。
对于优势皮质病变，尤其是患者没有明显神经功能缺损时，神经外科医生进行全切除具有挑战性。及时全切除孤立的转移瘤可改善患者预后，并能促进早期恢复，减少或不出现并发症。
