Recurrence of a Cerebral Arteriovenous Malformation after Surgical Excision

Abstract

Complete resection of a cerebral arteriovenous malformation (AVM) should eliminate the future risk of an associated intracranial bleeding. 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 complete removal has been achieved. However, even angiographically confirmed excision of an AVM does not completely exclude the possibility of rebleeding. Regrowth of an AVM with subsequent haemorrhage has been documented in children and is attributed to forces acting on the immature vasculature. The authors report the case of a 21-year-old man whose AVM recurred 5 years after angiographically proven complete excision. According to the presented case, the authors emphasise that, even in adults, angiographic documentation of total removal does not always eliminate the risk of reformation of an AVM.

Proliferation Activity Is Significantly Elevated in Partially Embolized Cerebral Arteriovenous Malformations

“…Cerebral AVMs are considered to be congenital lesions [4] and are characterized by a failure of the embryonic vascular plexus to fully differentiate and develop a mature capillary bed in the affected area. However, the de novo development and growth of AVMs [5,6,7,8,9,10] or regrowth following complete resection [11,12,13,14,15], which cannot be attributed only to the congenital pattern, have also been shown. Previous studies demonstrated an involvement of angiogenic factors in the pathogenesis of AVMs.…”

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

“…They suggested that recurrence caused by microshunts might remain invisible on early postoperative angiography. Some authors suggested that regrowth of childhood AVM may be attributable to the inherent nature of the development of an original abnormal vasculature 4) . Recurrence is definitely more common in children than in adults.…”

“…The recurrent nidal core had to gather vessels from remote areas. From the review of literatures, we found 4 cases of recurrent AVMs that recruited the feeders from remote area for forming new nidus; three of four 10) had new deep arterial feeding vessels (choroidal arteries, lenticulostriate arteries) that were not present originally and the one of four 4) had deep arterial feeders (anterior and posterior choroidal arteries) initially and superficial arteries (branches of PCA and callosomarginarl artery) were then involved. Therefore, recurrence or regrowth should be an active process, and VEGF or innate angiogenetic potential may play a role in these processes.…”

“…The second presentation would be more serious. There were two cases in which the lesion recurred twice in the literature, 3,4,11) and one case involved a woman who initially presented at the age of 33 years and experienced the second recurrence at the age of 42 3) .…”

“…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.…”