Recurrence of a cerebral arteriovenous malformation after surgical excision

Abstract

Complete excision of a cerebral arteriovenous malformation (AVM) should eliminate the future risk of an associated intracranial hemorrhage. Because total removal of an AVM may be difficult to assess at the time of surgery, postoperative angiography has become the accepted standard for documenting that the removal has been accomplished. However, even angiography confirmed excision of an AVM does not completely ensure against rebleeding. Regrowth of an AVM with subsequent hemorrhage can occur. This has been documented in children and is attributed to forces acting on the immature vasculature of these younger patients. The authors report the case of an older patient whose AVM recurred when he was 28 years of age, despite an angiography proven complete excision, and emphasize that, even in adults, angiography documentation of total removal does not always eliminate the risk of reformation of an AVM.

De Novo Cerebral Arteriovenous Malformation: Case Report and Literature Review

“…17,18 Several cases of AVM recurrence in the same location following some form of intervention (ie, gamma knife, excision, embolization, etc) have been reported in pediatric patients and adults. 19,20 Abnormalities of arterial 21 venous, 22 and microvascular 23 structures have been described in relation to areas of abnormal neuronal migration. Abnormal vascular structures have been described in association with periventricular nodular heterotopia in filamin 1 gene mutation, 23 suggesting 1 potential link between neuronal migrational disorders and vascular malformations.…”

Surgical Treatment of Non-ruptured Giant Occipital Arteriovenous Malformations With Frequent Migraine-Like Headache-Two Case Reports-

“…19) Previous cases of AVM recurrence after surgical excision and postoperative angiographic disappearance suggest that regrowth of the remnant arteriovenous shunt will result in development of de novo AVM nidus. 2,7) We speculate that development of the dural feeders might further enhance gradual growth of the nidus, resulting in homonymous hemianopia. Giant occipital AVMs might enlarge beyond the extent of the occipital lobe, becoming inoperable and incurable, and as a result, the severe migraine-like headaches and AVM will persist.…”

Recurrent Cerebral Arteriovenous Malformation in a Child : Case Report and Review of the Literature

“…If more mature AVMs develop along a continuum as the brain develops, children are more likely to have immature vasculature as part of their AVM. Immature vessels left in the surgical bed may not be visible on angiography, but they may retain the ability to regrow and form a new malformation in the same location 5) . This hypothesis is supported by the findings of Klimo et al 11) , who reported that diffuse lesions were disproportionately represented in cases of failed obliteration, residual lesion, or recurrence.…”

“…Complete excision or obliteration of the lesion usually eliminates the risks of hemorrhage, and a negative cerebral angiogram is generally considered indicative of a cure. Although recurrence of cerebral AVMs is rare, there are several reports of cerebral AVM recurrence in both children 1,2,4,[9][10][11] and adults 3,5,8,16) after complete resection verified by postoperative angiography.…”