Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms

The most common primary cardiac tumor is myxoma, typically originating in the left atrium. Emboli to the central nervous system can cause cerebral infarction or, rarely, seed tumor growth within vessel walls, causing myxomatous aneurysms. Fewer than 60 myxomatous aneurysms have been reported, including 2 cases in children. Here, the authors describe 2 different growing myxomatous aneurysms in a child successfully managed using a combined multidisciplinary approach. A 12-year-old boy developed a sudden headache, diplopia, gait instability, and speech difficulty. Magnetic resonance imaging revealed a left parietal hemorrhage and multifocal cerebral infarction, suspicious for an embolic etiology. A cardiac myxoma was identified in the left atrium and resected. Follow-up cranial vasculature imaging demonstrated multiple intracranial myxomatous aneurysms. These lesions were followed up, and serial imaging identified marked growth of 2 of them (right occipital and left parietal), prompting invasive intervention. The deep occipital lesion was better suited to endovascular treatment, while the superficial parietal lesion was amenable to resection. The patient underwent embolization of an enlarging fusiform aneurysm of the distal right posterior cerebral artery, followed by a left parietal craniotomy for a lesion of the distal left middle cerebral artery. Both procedures were performed without complications and achieved successful obliteration of the lesions, as confirmed by catheter angiography at the 30-month follow-up. To the authors' knowledge, this report illustrates the first combined endovascular and open surgical treatment of 2 myxomatous aneurysms in a single patient. While acknowledging the rarity of this condition, this report illustrates the clinical manifestations and treatment challenges posed by myxoma and details a successful strategy that could be employed in similar scenarios.