Delayed recanalization of a cerebral arteriovenous malformation following angiographic obliteration with polyvinyl alcohol embolization.

BACKGROUND

The efficacy of embolization of cerebral arteriovenous malformations (AVMs) is presently being evaluated. Embolization of single pedicle AVMs may produce complete angiographic obliteration and has been suggested as the sole therapy for treating these lesions.

METHODS

A 17-year-old female presented with a left intraventricular and intraparenchymal cerebral hemorrhage resulting from a 1 cm left posterior choroidal AVM. She subsequently underwent polyvinyl alcohol (PVA) embolization of the AVM with complete angiographic obliteration.

RESULTS

At 9 months follow-up, no evidence of recanalization of the AVM nidus was seen. Two years later, recanalization of the nidus was seen; and the patient received radiosurgical treatment. The natural history of previously embolized AVMs is reviewed and the mechanisms for recanalization are discussed.

CONCLUSION

We recommend that patients with angiographic obliteration of AVMs receive further treatment, preferably resection, or be followed with serial angiography.