Surgical Reexploration of a Cerebral Arteriovenous Malformation Remnant: Literature Review and Illustrative Case

Background: Cerebral arteriovenous malformation (AVM) is an abnormal tangle of blood vessels forming an aberrant connection between arteries and veins and bypassing capillaries. Its prevalence varies from 10 to 18 cases per 100,000 adults. Treatment options for cerebral AVM include microscopic surgical resection, endovascular embolization, and stereotactic radiosurgery. While the first-line management of AVM remains an area of controversy due to the availability of multiple treatment modalities, complete surgical resection remains the only option to provide immediate obliteration and definite elimination of the risk of bleeding, particularly in AVMs that have already bled. The management of residual AVMs is currently subject to much controversy. Here, we report an incident of missing AVM nidus during right perisylvian AVM surgery, addressing the possible causes, treatment, and means for preventing such complications during the microsurgical resection of AVMs.

Methods: A PubMed-based search was conducted using the formula: ((Intracranial Arteriovenous Malformations [MeSH Terms]) AND ((Residual[Title/Abstract]) OR (remnant[Title/Abstract]) OR (recurrence[Title/Abstract])) AND (surgery[Title/Abstract]). In addition, the reference list of the included articles was screened for additional papers.

Results: A total of 20 articles were included in the study. The age of the patient ranges from 19 to 56 years. The female-to-male ratio is 5:8. Moreover, other parameters were considered, which include the initial presentation (most commonly intracranial hemorrhage n = 5 55%), location of the AVM (parietal lobe is the most common site n = 6 46%), AVM size (ranging from 1.5 to 7 cm), eloquent area (n = 2 33%), deep veins drainage (n = 5 71%), preoperative embolization (n = 4 28%), and other parameters.

Conclusions: Residual nidus is a rare yet critical complication following microsurgical resection of cerebral arteriovenous malformations. Sophisticated planning with extensive preoperative imaging, meticulous intraoperative exploration of the surgical field along with the use of advanced intraoperative imaging studies may aid in minimizing the possibility of such dreadful complications, and early surgical reexploration may provide the greatest reduction in the risk of rebleeding.

Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023

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