The influence of neurological disorders before cardiac myxoma surgery on the rate of postoperative recurrences: Analysis of 317 patients in a single center. World neurosurgery. 2021 [참여저자]

Byul Hee Yoon 1, Joonho Byun 2, Moinay Kim 2, Seungjoo Lee 2, Jung Cheol Park 2, Jae Sung Ahn 2, Wonhyoung Park 3

DOI: 10.1016/j.wneu.2021.10.144

Abstract

Background: Cardiac myxoma is a very rare disease for which resection is the gold standard treatment. Many neurological manifestations are associated with this disease, including embolic infarctions, arterial aneurysms, and brain metastatic myxomas, but few large-scale studies have addressed this. The aim of this study was to retrospectively analyze the incidence, type, and prognosis of these neurological disorders.

Methods: We enrolled 317 patients who underwent a cardiac myxoma resection between 2004 and 2019 at our institution. A retrospective review of medical records and radiological imaging was performed for each patient, and clinical factors were compared and analyzed with regard to clinical outcomes and the incidence of adverse events.

Results: Patients with a neurological disorder before surgery were found to be more likely to develop new postoperative neurological complications (P = 0.003). Patients with a neurological disorder arising at any time before or after surgery had poorer outcomes (P < 0.001).

Conclusions: The clinical management of cardiac myxoma must take account of neurological sequelae independently of the surgical intervention to remove the lesion. Patients with cardiac myxoma and any neurological disorder should undergo both neurosurgical follow-up and cardiac surgical follow-up, even if myxoma removal surgery has been performed. We recommend active neuroimaging during long-term follow-up as essential in these cases.

Keywords: Aneurysm; Cardiac myxoma; Ischemia; Metastatic myxoma; Myxoma; Neurological disorders.

Figure 2. (A) Three-dimensional reconstruction image showing a myxomatous aneurysm in the inferior trunk of the left middle cerebral artery. (B) Microscopic view of a left myxomatous aneurysm. (C) Computed tomography showing a clipped myxomatous aneurysm of the middle cerebral artery with a dense subarachnoid hemorrhage in the left sylvian cistern. (D) Digital subtraction angiography anteroposterior view showing complete occlusion of the proximal artery of the aneurysm by coil embolization (white arrowheads). (E) Angiography anteroposterior view showing the distal part of an aneurysm identified through the superficial temporal artery–middle cerebral artery anastomosis site on the external carotid artery (white arrowheads). (F) Follow-up magnetic resonance angiogram obtained after 6 months showing the distal part of the aneurysm looking faint. A, aneurysm; F, frontal lobe; M3, M3 segment of the middle cerebral artery; T, temporal lobe; V, sylvian veins.