Recurrent cerebral arteriovenous malformations after negative postoperative angiograms

Abraham Kader, James Tait Goodrich, William J. Sonstein, Bennett M. Stein, Peter W. Carmel, W. Jost Michelsen

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Angiography has been considered to be the gold standard to judge the success of treatment for cerebral arteriovenous malformations (AVMs). Patients without residual nidus or early draining veins on postoperative angiograms are considered cured, with the risk of hemorrhage eliminated. A series of five patients with recurrent AVMs after negative postoperative angiography is described. All patients had hemispheric AVMs, presented initially with hemorrhage, and were between 5 and 13 years of age. Recurrence was noted 1 to 9 years later (at 12-16, years of age); after a hemorrhage in three patients, seizures in one, and on follow-up magnetic resonance imaging in one. Four patients underwent angiography that showed recurrence of the AVM at or adjacent to the original site. Three years postsurgery, the fifth patient died from a large intracerebral and intraventricular hemorrhage originating in the previous location of the AVM: however, the patient did not undergo angiography at the time of recurrence. The initial negative angiograms obtained postoperatively in these patients may be explained by postoperative spasm or thrombosis of a small residual malformation. However, in the authors' cumulative experience with 808 patients who have undergone complete surgical removal of AVMs (of whom 667 were older than 18 years of age), no case of recurrent AVM has been observed in an adult. Therefore, actual regrowth of an AVM may occur in children and could be a consequence of their relatively immature cerebral vasculature and may involve active angiogenesis mediated by humoral factors. The present findings argue against the assumption that AVMs are strictly congenital lesions resulting from failure of capillary formation during early embryogenesis. It is concluded that delayed imaging studies should be considered in children at least 1 year after their initial negative postoperative arteriogram to exclude a recurrent AVM.

Original languageEnglish (US)
Pages (from-to)14-18
Number of pages5
JournalJournal of Neurosurgery
Volume85
Issue number1
StatePublished - Jul 1996
Externally publishedYes

Fingerprint

Intracranial Arteriovenous Malformations
Arteriovenous Malformations
Angiography
Hemorrhage
Recurrence
Cerebral Hemorrhage
Spasm
Embryonic Development
Veins
Seizures
Thrombosis
Magnetic Resonance Imaging

Keywords

  • arteriovenous malformation
  • cerebral angiography
  • congenital angiogenesis
  • embryogenesis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Kader, A., Goodrich, J. T., Sonstein, W. J., Stein, B. M., Carmel, P. W., & Michelsen, W. J. (1996). Recurrent cerebral arteriovenous malformations after negative postoperative angiograms. Journal of Neurosurgery, 85(1), 14-18.

Recurrent cerebral arteriovenous malformations after negative postoperative angiograms. / Kader, Abraham; Goodrich, James Tait; Sonstein, William J.; Stein, Bennett M.; Carmel, Peter W.; Michelsen, W. Jost.

In: Journal of Neurosurgery, Vol. 85, No. 1, 07.1996, p. 14-18.

Research output: Contribution to journalArticle

Kader, A, Goodrich, JT, Sonstein, WJ, Stein, BM, Carmel, PW & Michelsen, WJ 1996, 'Recurrent cerebral arteriovenous malformations after negative postoperative angiograms', Journal of Neurosurgery, vol. 85, no. 1, pp. 14-18.
Kader A, Goodrich JT, Sonstein WJ, Stein BM, Carmel PW, Michelsen WJ. Recurrent cerebral arteriovenous malformations after negative postoperative angiograms. Journal of Neurosurgery. 1996 Jul;85(1):14-18.
Kader, Abraham ; Goodrich, James Tait ; Sonstein, William J. ; Stein, Bennett M. ; Carmel, Peter W. ; Michelsen, W. Jost. / Recurrent cerebral arteriovenous malformations after negative postoperative angiograms. In: Journal of Neurosurgery. 1996 ; Vol. 85, No. 1. pp. 14-18.
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