Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery: Case report

Bernard R. Bendok, Christopher C. Getch, Mir Jafer Ali, Todd Parish, H. Hunt Batjer, Michael T. Lawton, Robert A. Solomon, Christopher S. Ogilvy

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex. CLINICAL PRESENTATION: The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM. INTERVENTION: The patient has been monitored for more than 1 year, without additional symptoms or therapy. CONCLUSION: We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.

Original languageEnglish (US)
Pages (from-to)1142-1146
Number of pages5
JournalNeurosurgery
Volume50
Issue number5
DOIs
StatePublished - May 1 2002

Fingerprint

Arteriovenous Malformations
Thrombosis
Angiography
Operating Rooms
Drainage
Frontal Lobe
Paresis
Reoperation
Veins
Seizures
Observation
Hemorrhage
Blood Pressure

Keywords

  • Eloquent cortex
  • Residual arteriovenous malformation
  • Thrombosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery : Case report. / Bendok, Bernard R.; Getch, Christopher C.; Ali, Mir Jafer; Parish, Todd; Batjer, H. Hunt; Lawton, Michael T.; Solomon, Robert A.; Ogilvy, Christopher S.

In: Neurosurgery, Vol. 50, No. 5, 01.05.2002, p. 1142-1146.

Research output: Contribution to journalArticle

Bendok, BR, Getch, CC, Ali, MJ, Parish, T, Batjer, HH, Lawton, MT, Solomon, RA & Ogilvy, CS 2002, 'Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery: Case report', Neurosurgery, vol. 50, no. 5, pp. 1142-1146. https://doi.org/10.1097/00006123-200205000-00038
Bendok, Bernard R. ; Getch, Christopher C. ; Ali, Mir Jafer ; Parish, Todd ; Batjer, H. Hunt ; Lawton, Michael T. ; Solomon, Robert A. ; Ogilvy, Christopher S. / Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery : Case report. In: Neurosurgery. 2002 ; Vol. 50, No. 5. pp. 1142-1146.
@article{816d4e9d413b4bf7b31a37c8e0c619b1,
title = "Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery: Case report",
abstract = "OBJECTIVE AND IMPORTANCE: The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex. CLINICAL PRESENTATION: The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM. INTERVENTION: The patient has been monitored for more than 1 year, without additional symptoms or therapy. CONCLUSION: We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.",
keywords = "Eloquent cortex, Residual arteriovenous malformation, Thrombosis",
author = "Bendok, {Bernard R.} and Getch, {Christopher C.} and Ali, {Mir Jafer} and Todd Parish and Batjer, {H. Hunt} and Lawton, {Michael T.} and Solomon, {Robert A.} and Ogilvy, {Christopher S.}",
year = "2002",
month = "5",
day = "1",
doi = "10.1097/00006123-200205000-00038",
language = "English (US)",
volume = "50",
pages = "1142--1146",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery

T2 - Case report

AU - Bendok, Bernard R.

AU - Getch, Christopher C.

AU - Ali, Mir Jafer

AU - Parish, Todd

AU - Batjer, H. Hunt

AU - Lawton, Michael T.

AU - Solomon, Robert A.

AU - Ogilvy, Christopher S.

PY - 2002/5/1

Y1 - 2002/5/1

N2 - OBJECTIVE AND IMPORTANCE: The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex. CLINICAL PRESENTATION: The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM. INTERVENTION: The patient has been monitored for more than 1 year, without additional symptoms or therapy. CONCLUSION: We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.

AB - OBJECTIVE AND IMPORTANCE: The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex. CLINICAL PRESENTATION: The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM. INTERVENTION: The patient has been monitored for more than 1 year, without additional symptoms or therapy. CONCLUSION: We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.

KW - Eloquent cortex

KW - Residual arteriovenous malformation

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=0036590026&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036590026&partnerID=8YFLogxK

U2 - 10.1097/00006123-200205000-00038

DO - 10.1097/00006123-200205000-00038

M3 - Article

C2 - 11950420

AN - SCOPUS:0036590026

VL - 50

SP - 1142

EP - 1146

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -