Rendering a ruptured arteriovenous malformation more susceptible to spontaneous obliteration as a possible treatment strategy for cerebral AVM

Abstract

Spontaneous regression of cerebral arteriovenous malformation (AVM) is a rare phenomenon, but its occurrence is an important consideration in treatment planning. A 58-year-old male was found to have a high-flow AVM of Spetzler–Martin Grade III. Before his scheduled treatment, the AVM ruptured with a large parenchymal hemorrhage. Following emergency decompressive surgery, a targeted embolization procedure was performed to obliterate the ruptured weak point and to reduce the shunting flow. The residual AVM became a malformation harboring angio-architectural factors favoring spontaneous obliteration. Together with other favorable clinical factors, including prior parenchymal hemorrhage and neurosurgical intervention, the residual AVM spontaneously regressed in 2 months. This case highlighted a possible treatment strategy in that, for a ruptured AVM in which definite treatment is not possible, an alternative is to treat the AVM into a situation in which as many favorable factors as possible for spontaneous AVM regression are present.

Partial Onyx embolization triggers spontaneous regression of cerebral AVM: A case report

“…The thrombosis of the residual arterial feeders, nidus, and draining veins occurred after partial embolization. This finding suggests that partial embolization of cerebral AVM is also an etiological factor of spontaneous regression, which is consistent with the hypothesis by Hsu et al 5 In order to reduce hemorrhagic risk, targeted partial embolization of the AVM may be an alternative treatment for some cases. Given the risk of bleeding in partially embolized AVM, the selection of patients and types of surgical strategy requires further investigation.…”

“…Only one case has been reported in the literature. 5 At present, the cause of spontaneous regression is still unclear. Some radiological features, such as small AVM size and single draining vein, are related to spontaneous regression.…”

“…Hsu et al reported a case of ruptured cerebral AVM. 5 The patient underwent emergency decompressive surgery, and embolization of the AVM with coils and n-butyl cyanoacrylate glue. The residual AVM spontaneously regressed in two months.…”