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Updated: May 22, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Follow-up imaging to detect recurrence of surgically treated pediatric arteriovenous malformations
Shih-Shan Lang1, Lauren A Beslow, Robert L Bailey
1Department of Neurosurgery, University of Pennsylvania Medical Center, PA, USA. shihshan.lang@uphs.upenn.edu
Insights
Pediatric arteriovenous malformation (AVM) recurrences typically happen within 15 months of resection. A compactness score of 1 predicted recurrence, and 1-year follow-up imaging is crucial for detection.
Area of Science:
- Pediatric Neurosurgery
- Vascular Neurology
- Neuroradiology
Background:
- The incidence of pediatric arteriovenous malformation (AVM) recurrence post-resection is not well-established.
- Current literature suggests potential benefits of delayed imaging (6-12 months) after initial negative postoperative angiograms.
Purpose of the Study:
- To determine the timing of AVM recurrences after surgical resection in pediatric patients.
- To identify neuroimaging modalities effective in detecting these recurrences.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing AVM resection (2005-2010).
- Postoperative follow-up using MR angiography (MRA) and conventional angiography.
- Correlation of AVM compactness score with recurrence probability.
Main Results:
- Recurrences were observed in 4 out of 28 patients (14.3%) between 50-60 weeks post-resection.
- No recurrences were noted in patients with negative 1-year angiograms.
- A lower AVM compactness score (diffuse AVM) was significantly associated with recurrence (p=0.0003).
Conclusions:
- All observed AVM recurrences occurred within 15 months of initial resection.
- Intraoperative angiography is recommended for ensuring complete resection.
- Conventional angiography is preferred over MRA for detecting smaller recurrent AVMs.
- One-year follow-up imaging appears sufficient to rule out late recurrences in this cohort.
Object:
The true postoperative incidence of arteriovenous malformation (AVM) recurrence in the pediatric population remains largely unreported. Some literature suggests that delayed imaging studies should be obtained at 6 months to 1 year after negative findings on a postoperative angiogram. The aim of this study was to describe the timing of AVM recurrences after resection and the neuroimaging modalities on which the recurrences were detected.
Methods:
This study was performed in a retrospective cohort of all pediatric patients treated surgically for AVM resection by a single neurosurgeon between 2005 and 2010. Patients were followed after resection with MR angiography (MRA) or conventional angiography, when possible, at various time points. A visual scale for compactness of the initial AVM nidus was used, and the score was correlated with probability of recurrence after surgery.
Results:
A total of 28 patients (13 female, 15 male) underwent an AVM resection. In 18 patients (64.3%) an intraoperative angiogram was obtained. In 4 cases the intraoperative angiogram revealed residual AVM, and repeat resections were performed immediately. Recurrent AVMs were found in 4 children (14.3%) at 50, 51, 56, and 60 weeks after the initial resection. Recurrence risk was 0.08 per person-year. No patient with normal results on an angiogram obtained at 1 year developed a recurrence on either a 5-year angiogram or one obtained at 18 years of age. All patients with recurrence had a compactness score of 1 (diffuse AVM); a lower compactness score was associated with recurrence (p = 0.0003).
Conclusions:
All recurrences in this cohort occurred less than 15 months from the initial resection. The authors recommend intraoperative angiography to help ensure complete resection at the time of the surgery. Follow-up vascular imaging is crucial for detecting recurrent AVMs, and conventional angiography is preferred because MRA can miss smaller AVMs. One-year follow-up imaging detected these recurrences, and no one who had negative results on an angiogram obtained at 1 year had a late recurrence. However, not all of the patients have been followed for 5 years or until 18 years of age, so longer follow-up is required for these patients. A lower compactness score predicted recurrent AVM in this cohort.
