Data_Sheet_1_Case report: Multiple brain metastases of atrial myxoma: Clinical experience and literature review.PDF

Myxoma is the most common type of benign cardiac tumor in adults, and it has a strong tendency to embolize or metastasize to distant organs. Patients with multiple brain metastases have rarely been seen in clinics; hence, standard treatment protocols for multimyxoma metastasis in the brain have not been established. We present the case of a 47-year-old female who had convulsions in the right hand and repeated seizures. Computed tomography revealed multiple tumor sites in her brain. Craniotomy was conducted to remove the tumor sites. However, recurrent brain tumors and unexpected cerebral infarctions occurred frequently shortly after the treatment because the cardiac myxoma had not been treated due to the patient's personal concerns. The myxoma was resected by gamma knife radiosurgery, and temozolomide was given prior to cardiac surgery. There has been no evidence of tumor recurrence from the 2 years following the surgery until the present. This case highlights the importance of prioritizing cardiac lesions over cerebral lesions; if a cerebral metastasis has been found, it is likely that the cardiac myxoma is already unstable, with high rates of spread and metastasis. Therefore, it is unwise to treat metastasis sites before the cardiac myxoma. Additionally, the case suggests that gamma knife radiosurgery combined with temozolomide is effective as treatment for multiple myxoma metastasis in the brain. Compared with conventional cerebral surgery, gamma knife radiosurgery is safer, causes less bleeding, and requires a shorter time for recovery.

黏液瘤（Myxoma）是成人最常见的良性心脏肿瘤，且具有极强的栓塞或向远处器官转移的倾向。临床上颅内多发转移瘤病例极为罕见，因此目前尚未建立针对颅内多发性黏液瘤转移的标准治疗方案。本文报告1例47岁女性患者，其临床表现为右手抽搐伴反复发作性癫痫。计算机断层扫描（Computed Tomography，CT）显示其颅内存在多发肿瘤病灶，遂行开颅手术切除肿瘤病灶。但因患者个人顾虑未及时处理心脏原发黏液瘤，术后短期内频繁出现脑肿瘤复发及意外脑梗死。后续通过伽马刀放射外科（gamma knife radiosurgery）切除心脏黏液瘤，并在心脏手术前予替莫唑胺（temozolomide）治疗。自术后2年随访至今，未发现肿瘤复发迹象。本病例凸显了优先处理心脏原发灶而非颅内转移灶的重要性：若检出颅内转移灶，提示心脏黏液瘤已处于不稳定状态，具有较高的扩散与转移风险，因此先处理转移灶并非明智之举。此外，本病例表明伽马刀放射外科联合替莫唑胺治疗颅内多发性黏液瘤转移安全有效；相较于传统开颅手术，伽马刀放射外科具有更高安全性、更少出血量及更短康复周期的优势。