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Updated: Jan 1, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Ectopic Recurrence of Arteriovenous Malformation After Radiosurgery: Case Report and Insight Regarding Pathogenesis
Mariko Kawashima1, Hirotaka Hasegawa1, Hiroki Kurita2
1Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
Background:
While prior studies reporting de novo arteriovenous malformations after birth are not uncommon, reports of ectopic recurrence of arteriovenous malformation after radiotherapy are scarce.
Case Description:
An 8-year-old girl with a ruptured cerebellar arteriovenous malformation was treated with stereotactic radiosurgery. The nidus was completely obliterated 17 months after stereotactic radiosurgery; however, 20 years later she had a rupture of a recurrent nidus that occurred adjacent to the original nidus, accompanied by a radiation-induced cyst. Surgical resection was performed, and subsequent pathologic examination revealed 2 different compartments: a typical nidus and a postirradiated degenerated nidus with an encapsulated hematoma. Immunohistochemical stains showed increased expression of Ki-67 and decreased expression of endoglin in endothelial cells in the recurrent nidus.
Conclusions:
Depletion in endoglin may lead to the formation of vessel malformations in the presence of angiogenic stimuli. This case serves as a strong reminder of the importance of long-term follow-up after stereotactic radiosurgery, especially for pediatric cases.
