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. 2023 Oct 2;6(14):CASE2352.
doi: 10.3171/CASE2352. Print 2023 Oct 2.

Recurrence of arteriovenous malformation in an adult patient after complete resection: illustrative case

Delfina C Mazza Elizalde  1 , Ricardo H Menendez  1   2 , Maximiliano Di Fabio  1 , Douglas Ruiz  1 , Juan Manuel Eiroa  1 , Catalina Vittar  1 , German Arias  1 , Horacio A Sole  1
Affiliations

Recurrence of arteriovenous malformation in an adult patient after complete resection: illustrative case

Delfina C Mazza Elizalde et al. J Neurosurg Case Lessons. .

Abstract

Background: 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.

Observations: 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.

Lessons: 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.

Keywords: arteriovenous malformation; de novo arteriovenous malformation; spontaneous intracerebral hematoma; vascular.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1
FIG. 1
A: Preoperative axial FLAIR MRI showed large flow voids in the right frontal opercular region. B: Preoperative lateral angiography showed the AVM with feeding arteries from the middle cerebral artery and superficial venous drainage to the superior sagittal sinus and superficial sylvian vein. FLAIR = fluid-attenuated inversion-recovery.
FIG. 2
FIG. 2
One-month postoperative angiography on which no anomalous vessels can be observed.
FIG. 3
FIG. 3
A: GRE MRI sequence obtained after the neurological event showed a right frontal hemorrhagic focus. B: Lateral angiography on which the formation of new vessels was seen (red arrows).
See this image and copyright information in PMC

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