REVIEW
Introdução: mais da metade dos tumores cardíacos primários são mixomas atriais (MA), que podem causar complicações neurológicas. Porém, os aneurismas intracranianos (AIs) relacionados a esses tumores são raros. A patogênese de AIs relacionados a MA não está bem estabelecida. O diagnóstico dos AIs pode ocorrer antes ou após a ressecção do MA. Não há diretrizes sobre o manejo desses pacientes.Objetivo: avaliar a ocorrência de aneurismas intracranianos em pacientes com mixoma atrial, bem como suas características clínicas e desfechos. Métodos: este estudo é uma revisão sistemática, realizada nas bases de dados PubMed, LILACS, Scielo, DOAJ e Cochrane, utilizando diferentes combinações das palavras-chave: mixoma atrial, complicações neurológicas, mixoma, aneurisma, aneurisma intracraniano, em combinações AND e OR. Resultados: foram analisados 62 relatos de casos, sendo 72,6% dos acometidos mulheres, com idade média de 46,31 anos. Um total de 64,5% dos aneurismas foram diagnosticados após a ressecção do mixoma. Predominam AIs fusiformes na artéria cerebral média (66,1%). Cefaleia, alterações visuais e distúrbios da fala foram os sintomas principais. O exame neurológico estava normal em 17,7%. Dentre os pacientes, 40,3% já apresentaram algum evento neurológico e 35,4% receberam tratamento conservador. Óbitos foram infrequentes. Conclusão: AIs em pacientes com MA são raros. Mulheres são mais acometidas que os homens, principalmente aos 50 anos; homens são mais acometidos aos 60 anos. Os AIs predominam na artéria cerebral média. Cefaleia é o principal sintoma. Manejo é controverso, menos de um terço recebe abordagem cirúrgica. No geral, há melhora neurológica e alta hospitalar.
Introduction: more than half of primary cardiac tumors are atrial myxomas (AM) and they may cause neurological complications. However, intracranial aneurysms (IAs) related to these tumors are rare. The pathogenesis of IAs associated with AM is not well established. IA diagnosis can occur before or after myxoma resection. There are no well-defined management guidelines for these patients. Objective: this study aims to assess the occurrence of IAs in patients with AMs, as well as their clinical characteristics and outcomes. Methods: this is a systematic review, performed in the databases PubMed, LILACS, Scielo, DOAJ and Cochrane, using different combinations of the keywords, atrial myxoma, neurological complications, myxoma, aneurysm, intracranial aneurysm in both AND and OR combinations. Results: a total of 62 case reports were analyzed, and 72.6% of patients were women, mean age of 46.31 years. A total of 64.5% of aneurysms were diagnosed after myxoma resection. Fusiform aneurysms affecting the middle cerebral artery predominated (66.1%). Headache, visual changes, and speech disturbances were the main symptoms. Neurological examination was normal in 17.7%. From these patients 40.3% presented with some neurological event and 35.4% received conservative treatment. Deaths were infrequent. Conclusion: IAs in patients with AM are rare. Women are more affected than men, especially around the age of 50, men were more affected at age of 60. Middle cerebral artery aneurysms were more prevalent. Headache was the main symptom. Management is controversial, and less than a third received a surgical approach. Overall, there is neurological improvement and hospital discharge.
1 MS, Student of Medicine, Medical School, Municipal University of São Caetano do Sul, São Caetano do Sul, SP, Brazil.
2 MD, PhD, Department of Neurology, University of São Paulo, São Paulo, SP, Brazil.
3 MD, PhD, Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, SP, Brazil.
Received Dec 12, 2022
Accepted Jan 18, 2023
