Cardiac phoenix in the brain-occult intracranial hemorrhagic metastases from completely resected atrial myxoma

Background: 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. Case Description: 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. Conclusion: 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.

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Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report

BMC Neurology ◽

10.1186/s12883-019-1474-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Yan Wan ◽

Hai Du ◽

Lei Zhang ◽

Shuang Guo ◽

Li Xu ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brain Metastases ◽

Cardiac Myxoma ◽

Cerebral Aneurysms ◽

Surgical Excision ◽

Atrial Myxoma ◽

Surgical Removal ◽

Left Atrial Myxoma ◽

Complete Surgical Excision

Abstract Background Cardiac myxoma is the most common benign cardiac tumor. Brain metastases or multiple cerebral aneurysms are extremely rare, especially for the case of both complications. Brain metastases are usually found at the same time or few months after the diagnosis or surgical removal of cardiac myxoma Case presentation We describe a case of patient, operated for a cardiac myxoma, who presented multiple central nervous system metastases associated, cerebral aneurysms and subsequent intracerebral hemorrhage Conclusions The long-term follow-up of the patients with atrial myxoma even after complete surgical excision is recommended, especially for the patient with central nervous system manifestations before atrial myxoma excision

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P841 Case report of cardiac myxoma presenting with palpitations in young female

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.490 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Nalmpantis

Keyword(s):

Case Report ◽

Mitral Valve ◽

Cardiac Function ◽

Left Atrium ◽

Cardiac Myxoma ◽

Young Female ◽

Normal Function ◽

Atrial Myxoma ◽

Surgical Removal ◽

Common Symptom

Abstract Funding Acknowledgements none Introduction Atrial myxoma is a benign tumor of the heart , most commonly found in left atrium. The tumor must be surgically removed, because if remain untreated can lead to embolism, to arrhythmia and/or obstruction of mitral valve. Case report A 29 years old female presented due to palpitations and fatigue In the last two-three months. From recent blood tests she had a normal hematocrit and normal function of the thyroid gland. From the physical examination she had a blood pressure of 95/55 mmHg, S1S2 without any murmur, ECG with sinus rhythm and rsr" pattern. A bedside transthoracic echocardiography has performed and the findings were normal left systolic cardiac function, normal right systolic cardiac function, a large mass in left atrium without obstruction of mitral valve and a mild mitral regurgitation. The young female has been submitted for surgical removal of the cardiac mass and the anatomopathological examination has confirmed the benign nature of the atrial myxoma. Conlusion A common symptom such as palpitations are , has lead the young female to us in order to evaluate her and finally to reveal a benign cardiac tumor . Abstract P841 Figure. myxoma

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P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.501 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Mouadili ◽

A Tamdy ◽

B El Fatmi ◽

S Elkarimi

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Cardiac Myxoma ◽

Clinical Manifestations ◽

Limb Ischemia ◽

Atrial Myxoma ◽

Surgical Removal ◽

Left Atrial Myxoma ◽

Tibial Arteries ◽

The Right

Abstract Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare. A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions. Surgical removal of the myxoma was done later and the patient recovered uneventfully. Conclusion Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors. FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery FIGURE 2: macroscopic view of gelatinous left atrial myxoma

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Gross total resection of intracisternal accessory nerve schwannomas using a familiar midline suboccipital subtonsilar approach

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz220 ◽

2019 ◽

Vol 2019 (7) ◽

Author(s):

Elias Antoniades ◽

Alkinoos Athanasiou ◽

Panagiotis Sarlis ◽

Ioannis Magras ◽

Ioannis Patsalas

Keyword(s):

Relevant Literature ◽

Accessory Nerve ◽

Gross Total Resection ◽

Neurological Deficits ◽

Cerebrospinal Fluid Leakage ◽

Spinal Root ◽

Total Resection ◽

Suboccipital Craniotomy ◽

Rare Lesion ◽

Chronic Headaches

Abstract Background Intracisternal Accessory Nerve Schwannomas (ANS) constitute a rare clinical entity with only a few cases reported so far. Their symptoms are usually due to brainstem compression and not manifested until they render of great size. Secondary neuropathy and muscle atrophy are other late signs. The hitherto reported literature advocates a suboccipital craniotomy as a suitable approach. In most of the cases the spinal root was the location tumor arose from. Gross total resection was possible to be carried out in most cases with only sporadic tolerable postoperative deficits reported. Case description We hereby present three cases of patients with intracisternal ANS treated in the same fashion. Two patients were male and one female. Two patients complained of mainly chronic headaches and neck pain, whereas in the third patient the lesion was found incidentally. Only one patient suffered post-operatively cerebrospinal fluid leakage and wound healing complication, which was treated with revision surgery and administration of antibiotics. None of the patients had postoperative neurological deficits. Furthermore, we conducted a review of the relevant literature where we noted that there is no consensus yet with regards to the appropriate surgical approach. Conclusions Based on relevant anatomical studies, we advocate that suboccipital subtonsilar approach provides a wide corridor to the area of lesion allowing complete and safe resection of intracisternal ANS. We thus support that, in most cases, the neurosurgeon should consider using this familiar approach for treating this rare lesion.

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Microemboli monitoring by trans-cranial doppler in patient with acute cardioemboliogenic stroke due to atrial myxoma

Neurology International ◽

10.4081/ni.2010.e5 ◽

2010 ◽

Vol 2 (1) ◽

pp. 5 ◽

Cited By ~ 2

Author(s):

Gregory Telman ◽

Orit Mesica ◽

Efim Kouperberg ◽

Oved Cohen ◽

Gil Bolotin ◽

...

Keyword(s):

Cerebral Artery ◽

Cardiac Myxoma ◽

Surgical Excision ◽

Interatrial Septum ◽

Acute Onset ◽

Atrial Myxoma ◽

Clonic Seizures ◽

The Right ◽

The Brain ◽

Trans Cranial Doppler

This is the first reported attempt to examine the emboliogenic potential of cardiac myxoma in patients with acute stroke through the monitoring of microembolic signals (MES) by transcranial doppler. A 43-year old woman was brought to the emergency department because of acute onset of generalized tonic-clonic seizures and left hemiplegia. A CT scan of the brain demonstrated a large acute infraction in the territory of the right middle cerebral artery (MCA) and another smaller one in the territory of the posterior cerebral artery on the same side. Trans-cranial doppler (TCD) microemboli monitoring did not reveal MES. Transesophagial echocardiography (TEE) identified a 5 cm left atrial mass, which was highly suspected to be an atrial myxoma attached to the interatrial septum and prolapsed through the mitral valve. After the TEE results were obtained, another TCD monitoring was performed. Again, there were no MES found in either of the MCAs. Our findings showed the absence of MES on two consecutive TCD examinations, suggesting a spontaneous occurrence, rather than the permanent presence, of embolization, even in the most acute phase of stroke. Thus, the tendency of myxomas to spontaneously produce multiple emboli emphasizes the need for the surgical excision of myxomas.

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Gross Total Resection Rates in Contemporary Glioblastoma Surgery

Neurosurgery ◽

10.1227/neu.0b013e31826d1e6b ◽

2012 ◽

Vol 71 (5) ◽

pp. 927-936 ◽

Cited By ~ 120

Author(s):

Philippe Schucht ◽

Jürgen Beck ◽

Janine Abu-Isa ◽

Lukas Andereggen ◽

Michael Murek ◽

...

Keyword(s):

Aminolevulinic Acid ◽

Complete Resection ◽

High Rate ◽

Gross Total Resection ◽

Neurological Deficits ◽

Total Resection ◽

Glioma Surgery ◽

Intraoperative Mapping ◽

Number Of Patients ◽

The Impact

Abstract BACKGROUND: Complete resection of contrast-enhancing tumor has been recognized as an important prognostic factor in patients with glioblastoma and is a primary goal of surgery. Various intraoperative technologies have recently been introduced to improve glioma surgery. OBJECTIVE: To evaluate the impact of using 5-aminolevulinic acid and intraoperative mapping and monitoring on the rate of complete resection of enhancing tumor (CRET), gross total resection (GTR), and new neurological deficits as part of an institutional protocol. METHODS: One hundred three consecutive patients underwent resection of glioblastoma from August 2008 to November 2010. Eligibility for CRET was based on the initial magnetic resonance imaging assessed by 2 reviewers. The primary end point was the number of patients with CRET and GTR. Secondary end points were volume of residual contrast-enhancing tissue and new postoperative neurological deficits. RESULTS: Fifty-three patients were eligible for GTR/CRET (n = 43 newly diagnosed glioblastoma, n = 10 recurrent); 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n = 51, no residual enhancement > 0.175 cm3); CRET was achieved in 89% (n = 47, no residual enhancement). Postoperatively, 2 patients experienced worsening of preoperative hemianopia, 1 patient had a new mild hemiparesis, and another patient sustained sensory deficits. CONCLUSION: Using 5-aminolevulinic acid imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared with the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies was likely to be the major drivers for this high rate of CRET/GTR.

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Treatment-related morbidity and the management of pediatric craniopharyngioma

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.7.peds11436 ◽

2012 ◽

Vol 10 (4) ◽

pp. 293-301 ◽

Cited By ~ 47

Author(s):

Aaron J. Clark ◽

Tene A. Cage ◽

Derick Aranda ◽

Andrew T. Parsa ◽

Kurtis I. Auguste ◽

...

Keyword(s):

Radiation Treatment ◽

Treatment Strategies ◽

Extent Of Resection ◽

Gross Total Resection ◽

Neurological Deficits ◽

Benign Tumors ◽

Subtotal Resection ◽

Total Resection ◽

Anatomical Relationship ◽

Vascular Structures

Object Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric craniopharyngioma. Methods The authors performed a systematic review of the published literature on pediatric craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. Results Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal resection (STR) was not associated with an increased rate of new neurological deficits. Gross-total was associated with increased rates of diabetes insipidus (OR 7.7, p = 0.05) compared with the combination of STR and radiotherapy (RT). The addition of RT to STR was associated with increased rates of panhypopituitarism (OR 9.9, p = 0.01) but otherwise similar rates of morbidities. Conclusions Although subject to the limitations of a literature review, this report suggests that GTR is associated with increased rates of endocrinopathies compared with STR + RT, and this should be considered when planning goals of surgery.

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Stereotactic Volumetric Resection of Thalamic Pilocytic Astrocytomas

Neurosurgery ◽

10.1227/01.neu.0000279725.13521.a3 ◽

2007 ◽

Vol 61 (1) ◽

pp. 66-75 ◽

Cited By ~ 47

Author(s):

Yaron A. Moshel ◽

Michael J. Link ◽

Patrick J. Kelly

Keyword(s):

New York ◽

Residual Tumor ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

New York University ◽

Total Resection ◽

Pilocytic Astrocytomas

Abstract OBJECTIVE To describe the surgical approaches, the radiographic and clinical outcomes, and the long-term follow-up of patients harboring thalamic pilocytic astrocytomas after radical resection by means of a stereotactic volumetric technique. METHODS Seventy-two patients with thalamic pilocytic astrocytomas underwent stereotactic volumetric resection by the senior author (PJK) at the Mayo Clinic between 1984 and 1993 (44 patients) and at New York University Medical Center between 1993 and 2005 (28 patients). Patient demographics, presenting symptoms, surgical approaches, neurological outcomes, pathology, initial postoperative status, and long-term clinical and radiographic follow-up were retrospectively reviewed. RESULTS On preoperative neurological examinations, 54 of the 72 patients had neurological deficits; of these, 48 had hemiparesis. Postoperative imaging demonstrated gross total resection in 58 patients and minimal (<6 mm) residual tumor in 13 patients. Tumor resection was aborted in one patient. On immediate postoperative examination, 16 patients had significant improvements in hemiparesis. Six patients had worsening of a preexisting hemiparesis and one had a new transient postoperative hemiparesis. There was one postoperative death. After 13 to 20 years of follow-up in the Mayo group (mean, 15 ± 3 yr) and 1 to 13 years of follow-up in the New York University group (mean, 8 ± 3 yr), 67 patients were recurrence/progression-free, one had tumor recurrence, and three had progression of residual tumor. There were two shunt-related deaths. On long-term neurological follow-up, 27 patients had significant improvements in hemiparesis; one patient with a postoperative worsening of a preexisting hemiparesis remained unchanged. There were no patients with new long-term motor deficits after stereotactic resection. CONCLUSION Gross total removal of thalamic pilocytic astrocytomas with low morbidity and mortality can be achieved by computer-assisted stereotactic volumetric resection techniques. Gross total resection of these lesions confers a favorable long-term prognosis without adjuvant chemotherapy and/or radiation therapy and leads to the improvement of neurological deficits.

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Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1725025 ◽

2021 ◽

Author(s):

Walid Elshamy ◽

Burak Ozaydin ◽

G. Mark Pyle ◽

Mustafa K. Baskaya

Keyword(s):

Cavernous Sinus ◽

Cerebellopontine Angle ◽

Cranial Nerves ◽

World Health ◽

Gross Total Resection ◽

Surgical Removal ◽

Total Resection ◽

Meckel’S Cave ◽

Who Grade ◽

Meckel's Cave

AbstractMicrosurgery of cavernous sinus (CS) lesions is generally considered to be associated with a high rate of morbidity and cranial nerve deficits. The success for surgical removal of CS meningiomas is debatable and achieving a good functional outcome with preservation of the cranial nerves is the goal. Surgery of these lesions is challenging, recurrence rates are high, and therapeutic strategies remain controversial. In this video, we present a case of a CS meningioma that extended to Meckel's cave and the posterior fossa in a 46-year-old woman with history of a left-sided cerebellopontine angle World Health Organization (WHO) grade-I meningioma with extension to the left CS. Seven years ago, she had a microsurgical resection of a Cerebellopontine angle (CPA) meningioma. She later received radiotherapy for the slowly growing meningioma of the posterior CS. The patient presented with newly onset headache and facial pain. Magnetic resonance imaging (MRI) showed a meningioma of the left CS and Meckel's cave extending into the ambient cistern, with a mild mass effect on the pons, and a size increase compared with prior imaging. Since this area previously received radiotherapy, and the patient was symptomatic from trigeminal compression, the decision was made to proceed with surgical resection of the tumor via combined transcavernous and anterior petrosectomy. Postoperatively, the patient woke up with the same neurological status. MRI confirmed gross total resection of the tumor. The histopathology was a WHO grade-II chordoid meningioma. The patient is currently receiving radiotherapy. This video demonstrates the surgical approach and the resection steps of this pathology.The link to the video can be found at: https://youtu.be/HrU1VOzUGWU.

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Intraventricular neuroepithelial tumors: Surgical outcome, technical considerations and review of literature

10.21203/rs.3.rs-56348/v2 ◽

2020 ◽

Author(s):

Amir Kaywan Aftahy ◽

Melanie Barz ◽

Philipp Krauss ◽

Friederike Liesche ◽

Benedikt Wiestler ◽

...

Keyword(s):

Postoperative Outcome ◽

Retrospective Chart Review ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

Total Resection ◽

Term Survival ◽

Neuroepithelial Tumors ◽

Glioependymal Cyst ◽

Tertiary Center

Abstract Background: Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods: We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009-05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications.Results: 45 IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80-100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months.Conclusion: Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.

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