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Cerebral aneurysms and atrial myxomas - a versatile correlation
EANS Academy. Nicolae L. 09/25/19; 275805; EP01014
Liviu Ionut Nicolae
Liviu Ionut Nicolae

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Abstract
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Introduction: The pathogenesis of myxoma related cerebral aneurysms is a complex phenomenon that has multiple factors that influence its outcome. Although a sporadic neurologic complication, aneurysms in the context of an atrial tumor raise various questions of the chronology of biochemical, hemodynamic and histopathologic processes that eventually lead to the formation of the cerebrovascular abnormality. This review aims to establish a systematic identification of the current issues that this association encounters and to assess the importance of a multidisciplinary neurosurgical and cardiosurgical approach.
Material and methods: A literature review was performed on Pubmed to evaluate all articles that involve the association of atrial myxomas and cerebral aneurysms. All articles that presented aneurysms in other anatomic regions such as the aorta or the heart, or studies depicting myxomas of other areas such as the maxillary sinus or mandible were excluded.
Results: Our search retrieved 227 articles, out of which only 79 publications were relevant to our intended review. 92 cases of myxomas, with ages varying between 11 and 73, in the context of aneurysmal complications have been identified. Female population was the most prone to this association of disorders and aneurysms occurred even after 25 years after the myxoma resection. The middle cerebral artery was the most frequent site of formation of aneurysms, but the vast majority of cases had associated multiple aneurysm on different arteries. A significant percentage of cerebral issues were managed conservatively but there have been a few cases reported with massive aneurysms that required active treatment with either clipping/resection.
Conclusions: Myxoma resection does contribute to avoiding precocious neurological complications, but there is no guarantee of an aneurysm free outcome, thus raising concerns in relation to the eligibility for certain therapeutic options. Further research must shed light on the predictability of these pathological elements and the appropriate treatment.
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