Recurrence of a cerebral arteriovenous malformation after surgical excision

Case report

Restricted access

✓ Complete excision of a cerebral arteriovenous malformation (AVM) should eliminate the future risk of an associated intracranial hemorrhage. 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 the removal has been accomplished. However, even angiographically confirmed excision of an AVM does not completely ensure against rebleeding. Regrowth of an AVM with subsequent hemorrhage can occur. This has been documented in children and is attributed to forces acting on the immature vasculature of these younger patients. The authors report the case of an older patient whose AVM recurred when he was 28 years of age, despite an angiographically proven complete excision, and emphasize that, even in adults, angiographic documentation of total removal does not always eliminate the risk of reformation of an AVM.

Article Information

Address reprint requests to: Eric M. Gabriel, M.D., Division of Neurosurgery, Box 3807, Duke University Medical Center, Durham, North Carolina 27710.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Anteroposterior (left) and lateral (right) left internal carotid angiograms demonstrating a left frontotemporal arteriovenous malformation.

  • View in gallery

    Anteroposterior (left) and lateral (right) left internal carotid angiograms obtained 7 days after the first operation confirming the complete obliteration of the arteriovenous malformation.

  • View in gallery

    Contrast-enhanced axial computerized tomography scan performed 9 years after the first operation demonstrating a recurrent left frontotemporal arteriovenous malformation.

  • View in gallery

    Anteroposterior (left) and lateral (right) left internal carotid angiograms confirming the regrowth of an arteriovenous malformation at the original location.

  • View in gallery

    Oblique (left) and lateral (right) left common carotid angiograms obtained 2 days after the second operation confirming the removal of the recurrent arteriovenous malformation.

References

  • 1.

    Amacher ALAllcock JMDrake CG: Cerebral angiomas: the sequelae of surgical treatment. J Neurosurg 37:5715751972Amacher AL Allcock JM Drake CG: Cerebral angiomas: the sequelae of surgical treatment. J Neurosurg 37:571–575 1972

  • 2.

    Davis CSymon L: The management of cerebral arteriovenous malformations. Acta Neurochir 74:4111985Davis C Symon L: The management of cerebral arteriovenous malformations. Acta Neurochir 74:4–11 1985

  • 3.

    Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:1452081979Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:145–208 1979

  • 4.

    Forster DMCSteiner LHåkanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:5625701972Forster DMC Steiner L Håkanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562–570 1972

  • 5.

    Guidetti BDelitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:1491521980Guidetti B Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149–152 1980

  • 6.

    Heros RCKorosue KDiebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:5705781990Heros RC Korosue K Diebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578 1990

  • 7.

    Jomin MLesoin FLozes G: Prognosis for arteriovenous malformations of the brain in adults based on 150 cases. Surg Neurol 23:3623661985Jomin M Lesoin F Lozes G: Prognosis for arteriovenous malformations of the brain in adults based on 150 cases. Surg Neurol 23:362–366 1985

  • 8.

    Kader AGoodrich JTStein BMet al: Recurrent cerebral AVM's after negative postoperative angiograms. J Neurosurg 82:342A1995 (Abstract)Kader A Goodrich JT Stein BM et al: Recurrent cerebral AVM's after negative postoperative angiograms. J Neurosurg 82:342A 1995 (Abstract)

  • 9.

    Kondziolka DHumphreys RPHoffman HJet al: Arteriovenous malformations of the brain in children: a forty year experience. Can J Neurol Sci 19:40451992Kondziolka D Humphreys RP Hoffman HJ et al: Arteriovenous malformations of the brain in children: a forty year experience. Can J Neurol Sci 19:40–45 1992

  • 10.

    Luessenhop AJ: Natural history of cerebral arteriovenous malformations in Wilson CBStein BM (eds): Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins1984 pp 1223Luessenhop AJ: Natural history of cerebral arteriovenous malformations in Wilson CB Stein BM (eds): Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins 1984 pp 12–23

  • 11.

    Nornes HLundar TWikeby P: Cerebral arteriovenous malformations; results of microsurgical management. Acta Neurochir 50:2432571979Nornes H Lundar T Wikeby P: Cerebral arteriovenous malformations; results of microsurgical management. Acta Neurochir 50:243–257 1979

  • 12.

    Padget DH: The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 98:3073551956Padget DH: The cranial venous system in man in reference to development adult configuration and relation to the arteries. Am J Anat 98:307–355 1956

  • 13.

    Paterson JHMcKissock W: A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain 79:2332661956Paterson JH McKissock W: A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain 79:233–266 1956

  • 14.

    Wilson CBU HSDomingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:4464541979Wilson CB U HS Domingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:446–454 1979

  • 15.

    Yaşargil MG: Microneurosurgery. Vol IIIA. AVM of the Brain History Embryology Pathological Considerations Hemodynamics Diagnostic Studies Microsurgical Anatomy. New York: Thieme1987 pp 150154Yaşargil MG: Microneurosurgery. Vol IIIA. AVM of the Brain History Embryology Pathological Considerations Hemodynamics Diagnostic Studies Microsurgical Anatomy. New York: Thieme 1987 pp 150–154

  • 16.

    Yaşargil MG: Microneurosurgery. Vol IIIB. AVM of the Brain Clinical Considerations General and Special Operative Techniques Surgical Results Nonoperated Cases Cavernous and Venous Angiomas Neuroanesthesia. New York: Thieme1988 pp 376379Yaşargil MG: Microneurosurgery. Vol IIIB. AVM of the Brain Clinical Considerations General and Special Operative Techniques Surgical Results Nonoperated Cases Cavernous and Venous Angiomas Neuroanesthesia. New York: Thieme 1988 pp 376–379

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 98 98 16
Full Text Views 120 120 2
PDF Downloads 86 86 0
EPUB Downloads 0 0 0

PubMed

Google Scholar