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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Recurrent cerebral arteriovenous malformations: Incidence and characteristics

Rezidive von kraniellen arteriovenösen Malformationen

Meeting Abstract

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  • corresponding author M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • T. Martens - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • U. Grzyska - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • H. Zeumer - Neuroradiologische Klinik, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.09.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc268.shtml

Published: May 30, 2008

© 2008 Westphal et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To estimate the rate of recurrent cerebral arteriovenous malformations and to define risk factors for their development.

Methods: Out of a single center series of 462 patients with cerebral arteriovenous malformations seen since 1988, 400 were actively treated resulting in 348 surgical cases. Of these cases, the majority was managed with combined endovascular preoperative embolization and resection. (232/348). A recurrence was defined as a true AVM with feeder(s), nidus and draining vein(s) which were definitely absent on one or more postoperative angiograms. This is clearly distinct from a growing residual (after a deliberate partial excision (one case) or transient hyperemia.

Results: Within this series, 5 cases were treated for true recurrences. 4 cases of this departmental series had undergone complete excision as proven by early postoperative angiogram and presented with a recurrence. One case presented 8 years after angiographically complete endovsacular obliteration elsewhere. Presentation at recurrence was with hemorrhage (1 case), seizures (2 cases) and unspecific symptoms leading to MRI (2 cases). In all cases the recurrence was completely excised. There were 3 females and 2 males, all below the age of 30 years at the time of initial treatment. The interval between the initial and the recurrent treatment ranged from 1 and 8 yrs. 4 lesions were grade III (Spetzler/Martin) and 1 was grade I. At angiography neither the primary nor the recurrent lesions had distinct, predictive angioarchitectonic characteristics. The only consistent finding was a regular component of diffuse secondary arterialization. No second recurrence has been seen up to date.

Conclusions: In a small percentage of cerebral AVMs (below 1% in this series), recurrences may be seen after complete elimination. The pathogenesis of such rare lesions remains obscure. In modern series the incidence tends to be lower than in earlier days when concepts such as "hidden compartments" or the "reserve nidus" were postulated but the reappearance of symptoms should be taken very seriously and thorough imaging done immediately to exclude a recurrence.