Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease

Abstract

<jats:p>The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.</jats:p>

Are parenchymal AVMs congenital lesions?

“…The indications for the initial evaluation were variable. These included vascular abnormalities (such as moyamoya disease, 15,28,31 dural arteriovenous fistula, 14 cavernous malformation with developmental venous anomaly, 4 AVMs 2 in other location, and intraparenchymal hemorrhage 25 ) and nonvascular conditions such as a brain tumor, 24 neuronal migration abnormality, 33 Bell's palsy, 23 head trauma, 16 and demyelinating lesions. 7 Repeat imaging leading to the diagnosis of the de novo AVM was performed after a prolonged interval, ranging from 2 to 17 years, for the purpose of following up the original lesion or due to the acute development of symptoms (which were related to AVM rupture in 3 cases).…”

Cerebral Arteriovenous Malformation Associated with Moyamoya Disease

“…Three de novo AVMs have been reported until recently3,5,14). One developed in the same region of a previous parietal infarct in an 11-year-old boy14).…”

“…The authors assumed that the hyperangiogenic environment of MMD in combination with the local angiogenic stimulation might have contributed to the development of the new AVM5,14). The last case is a de novo occipital AVM that developed after bilateral revascularization surgery in a 14-year-old girl3). The authors assumed that, because they did not perform extended indirect pial synangiosis and/or an additional burr-hole trephination in the posterior circulation, the initiation of AVM development could not have been due to the iatrogenic arteriovenous fistula.…”

De Novo Arteriovenous Malformation in a 4 Year-Old Boy with Headache, with No Previous Cerebrovascular Disease

“…The case presented herein adds to only 15 reported cases of de novo AVM [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] that challenge the concept of congenital aetiology. Furthermore, this case is only the eighth case described in a child without underlying cerebrovascular disease such as moya-moya disease, or a history of previous vascular malformation ( Table 1).…”