Dysplastic Vessels After Surgery for Brain Arteriovenous Malformations

Abstract

Background and Purpose-The cause and clinical significance of residual dysplastic vessels after surgery for brain arteriovenous malformations (AVM) are unclear. We studied predictors and frequency of residual dysplastic vessels on cerebral angiography after AVM surgery. Methods-The 240 prospectively enrolled surgical patients from the New York AVM Databank underwent 269 AVM-related surgical procedures. Reported postoperative brain angiographic findings were classified post hoc as showing (1) persistent dysplastic vessels, (2) a residual AVM, (3) focal hyperemia in the surgical bed, (4) other changes, or (5) a normal angiogram. Univariate and multivariate models were applied to test for an association between residual dysplastic vessels and patient age, sex, preoperative AVM size, anatomic AVM location, number of embolization procedures before surgery, and the time interval between AVM surgery and the postoperative angiogram. Results-Of the 224 documented postoperative angiograms, 78 (35%) showed dysplastic vessels, 24 (11%) had evidence for a residual AVM, 16 (7%) showed focal hyperemia, 6 (2%) revealed other findings, and 100 (45%) were normal. The number of cases showing angiographic evidence for dysplastic vessels was significantly associated with increasing size of the AVM (in millimeter increments; Pϭ0.0001); the mean diameter of AVMs in patients showing dysplastic vessels after surgery was significantly larger (41 mm, SD Ϯ14) than in those without residual dysplastic vessels (27 mm, SD Ϯ13; PϽ0.001). Symptomatic postoperative intracerebral hemorrhage occurred in 4 patients (1%), in 2 of whom dysplastic vessels were seen on the postoperative angiogram. Conclusions-The findings suggest that persistent dysplastic vessels may be found in approximately one third of angiograms after AVM surgery. Preoperative AVM size was found to be an independent predictor for the occurrence of dysplastic vessels on the postoperative angiogram.

Residual brain AVMs after surgical resection: A literature review of causes and treatment considerations

“…The mean size was 3.96 cm, which is slightly higher than the mean size of 2.75 cm reported by Englot et al 21 In a prospective study conducted by Stapf et al involving 240 patients undergoing surgical resection for AVM, no association was found between the size and location of the original AVM and the rate of residual AVM. 35 Of note, the role of surgical resection of large AVMs has been limited. Resection has traditionally been preferred for smaller AVMs, with some studies recommending a focus on resecting AVMs smaller than 3 cm as they are associated with better outcomes post-resection.…”

Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study

“… 33 In the follow-up of treated AVMs, superselective angiographic exploration could help clarify the dysplastic vessels visualized around the treated AVM that might result in further bleeding. 34 …”

The Prognosis and Treatment of Arteriovenous Malformations of the Brain

“…Intra-operative angiography seems safe in the evaluation of the desired anatomical treatment result before the surgical intervention has been completed (Vitaz et al 1999). Persistent dysplastic arteries on the post-operative angiogram have not been proven to represent a morphological risk factor for bleeding in the surgical bed (Stapf et al 2002a), but hypotensive therapy has been recommended in such cases after surgery Size of AVM Small (< 3 cm) 1 Medium (3-6 cm) 2 Large (> 6 cm) 3 (10-20% below baseline resting mean arterial pressure) with slow return to normotension after 24-48 h.…”