Recurrence of Completely Excised Arteriovenous Malformation: Review of the Literatures and Possible Explanation

Abstract

The authors report a case of recurrent arteriovenous malformation (AVM), which has been completely removed and disappeared on postoperative angiography four years ago. Initially, at the age of nine years, she presented intracerebral hematoma. The angiography demonstrated an aneurysm and AVM nidus located in the posterior frontal area, fed by the branches of the anterior and middle cerebral arteries. Eleven days after the ictus, rebleeding occurred, so left fronto-parietal craniotomy was done emergently. The hematoma and AVM nidus with aneurysm were removed. Her postoperative course was uneventful and postoperative angiography showed that the AVM had been completely excised. However, four years later, sudden focal motor seizure on right leg developed. Magnetic resonance (MR) images and angiography demonstrated that the AVM reappeared on the previously operated region. Extirpation of the recurrent AVM was carried out. We do emphasize a long term follow-up MR images or a repeated angiography is essential to confirm the complete absence after excision of the AVM.