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World Neurosurg. 2018 Aug;116:e856-e866. doi: 10.1016/j.wneu.2018.05.117. Epub 2018 May 26.

Recurrent Brain Arteriovenous Malformations (AVMs): A Systematic Review.

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Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, University of Toronto, Toronto, Ontario, Canada.
Department of Neurologic Surgery, Institute of Neurological Sciences of Bologna, Bologna, Italy.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address:



Risk factors for the recurrence of surgically excised brain arteriovenous malformations (AVMs) are poorly understood. In addition, ideal follow-up imaging paradigms to catch AVM recurrences are not well defined. We present a systematic review on risk factors for the recurrence of surgically resected AVMs and identify potential theories of recurrence.


A literature search was performed by a reference librarian, and after screening, 14 case reports and 16 case series were left for inclusion in the review. All possible data were abstracted by 2 authors, and the results were tabulated and descriptive statistics (mean, range; and proportions) were reported. No formal statistical analysis was performed as part of this study.


Systematic review of the literature revealed 73 patients with a surgically resected AVM that recurred. The average age of first AVM presentation was 13.8 years, and most patients presented with hemorrhage (90%). After angiographically confirmed complete surgical resection, average time to AVM recurrence was 4.2 years. Rate of recurrence was 2.7% in adult series or case reports (n = 8). When we analyzed only pediatric case reports or series (n = 12), the average rate of recurrence was 9.5% but was as high as almost 14% in a series with compulsory short-term follow-up serial imaging. Four (5.5%) patients experienced re-recurrence of AVM after complete surgical excision of first AVM recurrence.


AVM recurrence after complete surgical resection is a recognized risk that occurs primarily in children. Follow-up imaging within 1 year of surgery is strongly indicated for pediatric patients with surgically resected AVMs, even with postoperative angiographically confirmed complete excision.


Arteriovenous malformation; Cerebrovascular; Endovascular; Neurosurgery; Recurrent; Review; Vascular

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