Multiple cerebral myxomatous aneurysms: what is the optimal treatment?

Multiple cerebral aneurysms resulting from cardiac myxoma is a very rare disease, and the optimal treatment is not yet determined. We present 2 cases of multiple cerebral myxomatous aneurysms and give an overview of the English literature pertaining to this disease.

We described 2 new cases of multiple cerebral myxomatous aneurysms and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): "neoplastic aneurysm," "oncotic aneurysm," "aneurysm," and "myxoma." Only patients with multiple cerebral aneurysms resulting from cardiac myxoma and contained adequate follow-up information pertinent to the analysis were included.

One patient underwent craniotomy for resection of an aneurysm. Microscopic examination demonstrated the myxoma in the aneurysmal wall. The other patient was managed conservatively. Thirty-five cases meeting the previously mentioned criteria were found in the literature. This disease was typically diagnosed in young adults (median age = 38 years). Females were more frequently affected (F/M ratio, 2.7:1). A total of 78.4% were managed conservatively. A total of 16.2% underwent craniotomy for aneurysm resection and/or hematoma evacuation. At follow-up, 64.9% were stable, 10.8% revealed disappearance of aneurysms, 10.8% showed enlargement of aneurysms, and the mortality rate was 13.5%.

Patients with multiple cerebral aneurysms should routinely be evaluated for cardiac myxoma and vice versa. Conservative treatment is recommended for most of the patients. Prognosis is good in most patients.