Hemorrhagic Venous Infarction after Excision of an Arteriovenous Malformation: Case Report

Abstract

A case of arteriovenous malformation (AVM) in which postoperative hemorrhagic infarction developed, probably because of occlusion of the former draining veins, is reported. The hemorrhage developed in the temporal lobe 3 days after the initial operation and was located in the immediate vicinity of the site of the AVM. The following findings suggest that the postsurgical hemorrhage probably resulted from a venous thrombosis: 1) no evidence of residual AVM; 2) delayed onset of the hemorrhage, inconsistent with the time course of a hemorrhage developing according to the breakthrough theory or with insufficient hemostasis with a high-pressure afterload; 3) good correlation between the location of the hemorrhage and the occlusion of the draining veins; and 4) multifocal hemorrhage affecting both the gray matter and the subcortical white matter. Postoperative hemorrhagic infarction caused by thrombosis in the draining veins is rare, but it should be considered as a distinct postoperative complication after removal of an AVM.

Multiple Arteriovenous Malformations with Hemorrhage

“…The mechanism of hemorrhage in the present case was di¨erent because the second hemorrhage was distant from the ®rst. Also, it was not a hemorrhagic infarction caused by venous thrombosis [11].…”

Early Draining Vein Occlusion After Gamma Knife Surgery for Arteriovenous Malformations

“…[12][13][14] According to Spetzler's ''normal perfusion pressure breakthrough'' theory, the vasculature adjacent to the nidus constantly receives low blood flow and loses its autoregulatory function. 13 Restoration of normal perfusion pressure after resection of the nidus drives the blood flow through the dysfunctional vascular bed causing hemorrhage or local edema.…”

Letter: Hemorrhage Following Complete Arteriovenous Malformation Resection With No Detectable Recurrence: Insights From a 27-Year Registry

“…Other cases supporting this finding have been published. [2][3][4] In all cases, the hemorrhage occurred within 2 d of surgical resection. Edema surrounding the hematoma is usually present.…”