心房黏液瘤合并多发性颅内动脉瘤患者的临床及影像学特点

Clinical and imaging features of atrial myxoma-related multiple cerebral aneurysms

目的:分析心房黏液瘤合并多发性颅内动脉瘤患者的临床及影像学资料,探讨其发病机制及其临床指导意义。方法:收集南方医科大学珠江医院神经内科自2005年1月至2010年6月收治10例心房黏液瘤合并多发性颅内动脉瘤患者的临床资料,进行为期3年的随访,分析其影像学特点和疗效。结果:8例患者的多发性颅内动脉瘤是在心房黏液瘤摘除术后半年或更长的时间发现;该类患者的主要临床表现为脑梗死或癫痫。CT平扫显示双侧大脑半球多发性结节样高密度灶,脑血管检查提示多发性颅内动脉瘤,前后循环均可受累。保守治疗病情平稳。结论:心房黏液瘤患者行黏液瘤摘除术后有出现迟发性多发性颅内动脉瘤的可能,术前及术后应定期行头颅影像学及脑血管检查。

Objective To understand the pathogenesis of myxoma-related aneurysms by collecting clinical and imaging features of atrial myxoma-related muhiple cerebral aneurysms. Method There were ten patients diagonosed as atrial myxoma-related multiple cerebral aneurysms from January 2005 to June 2010 in hospital. A three years follow up plan for ten patients with myxomatous aneurysms, Results Eight cases of multiple cerebral mycotic aneurysms occurred 6 months or more long time after cardiac myxoma resection. Neurological complications of myxomatous aneurysms are stroke and epilepsy. CT scan shows multiple tuberculiform slightly higher density focies in bilateral cerebral hemispheres. Patients underwent CTA and MRA or DSA examinations, which revealed multiple cerebral mycotic aneurysms. Anterior circulation and posterior circulation aneurysms were observed. The patient remains healthy, suggesting that in such cases we should also consider conservative treatment. Conclusions Cardiac .surgery to remove the primary cardiac tumour cannot completely eliminate the risk of delayed cerebral aneurysm formation. We propose that cerebral CTA MRA or DSA scan should be performed before and after operation in all patients with a cardiac myxoma.