Complete resection of an arteriovenous malformation (AVM) is considered a curative treatment. In this paper the authors discuss two possibilities in the event of hemorrhage after satisfactory resection of an AVM: recurrence or remnant.
A 33-year-old female patient was diagnosed with an incidental right frontal AVM that was microsurgically resected and whose postoperative angiography showed no remnant. Eight years later, she presented with an episode of headache and speech arrest. Magnetic resonance imaging showed bleeding in the previous surgical site, and a new angiography revealed the presence of a vascular blush not seen previously. The patient did not show the most frequently associated factors for recurrence described in the literature, which are hemorrhage on presentation and deep venous drainage. In addition, factors related to undetected vascular remnants, such as preoperative hemorrhage and early postoperative angiography, were absent.
Considering the characteristics of the case, we believe that the most likely explanation is the development of a de novo vascular formation secondary to factors not yet elucidated. Preexisting views on AVM formation, the curative value of resection, and long-term follow-up in certain patients should be reevaluated.