Case Report: Craniotomy and radiotherapy for multiple hemorrhagic cerebral lesions from resected cardiac myxoma.

This report elaborates on a unique case of multiple cerebral lesions from completely resected atrial myxoma which was treated with craniotomy and radiotherapy. A 56-year-old female presented with progressive headache, left limb weakness and low-grade fever for over 20 days. She had undergone total resection of left atrial myxoma nine months before. MRI revealed multiple hemorrhagic lesions in both cerebral hemispheres and left cerebellum. The symptomatic lesion in the right parietal lobe was resected under neuronavigation, ultrasound and electrophysiological monitoring. Pathology confirmed myxoma seeding. Whole-brain radiotherapy (30 Gy in 15 fractions) was administered for the remaining multiple lesions. During 14 months of follow-up, the patient's left limb muscle strength improved from grade V- to grade V, MRI showed no disease progression, and Karnofsky Performance Status (KPS) increased from 70 preoperatively to 90. One epileptic seizure was well controlled with medication.