- Department of Surgery, Division of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore
Aaron Song Chuan Foo
Department of Surgery, Division of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore
DOI:10.4103/2152-7806.180766Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Lim SL, Chuan Foo AS, Karlsson B, Yeo TT. Spontaneous obliteration highlights the dynamic nature of cerebral arteriovenous malformations: A case report and review of the literature. Surg Neurol Int 20-Apr-2016;7:45
How to cite this URL: Lim SL, Chuan Foo AS, Karlsson B, Yeo TT. Spontaneous obliteration highlights the dynamic nature of cerebral arteriovenous malformations: A case report and review of the literature. Surg Neurol Int 20-Apr-2016;7:45. Available from: http://surgicalneurologyint.com/surgicalint_articles/spontaneous-obliteration-highlights-the-dynamic-nature-of-cerebral-arteriovenous-malformations-a-case-report-and-review-of-the-literature/
Background:Cerebral arteriovenous malformations (AVMs) are dynamic lesions and have been documented to arise de novo, enlarge, regress, obliterate, and even recur. Spontaneous obliteration of AVM is a rare and poorly understood phenomenon.
Case Description:We present a case of spontaneous obliteration of AVM in a 60-year-old gentleman who presented with intraparenchymal hemorrhage from a ruptured right parieto-occipital AVM. Angiography performed before gamma knife surgery 4 months after his initial presentation demonstrated complete absence of AVM.
Conclusion:In our center's 20-year experience of treatment of cerebral AVMs (approximately 600 cases), this is the only case that has been aborted due to spontaneous obliteration leading us to infer that the incidence of spontaneous AVM obliteration is
Keywords: Cerebral arteriovenous malformation, dynamic lesion, spontaneous obliteration
Gamma knife surgery is a well-established treatment modality for small and medium-sized cerebral arteriovenous malformations (AVMs). It has been used in Singapore since 1995, and around 600 AVMs have been treated. The following is the first case in our experience in which the AVM could not be visualized on stereotactic digital subtraction angiography in a patient scheduled for gamma knife surgery. This prompted us to explore the dynamics behind spontaneous obliteration of AVMs.
The patient is a 60-year-old gentleman who presented with acute intracerebral hemorrhage in the right parieto-occipital region [
Digital subtraction angiography performed 5 days after the initial hemorrhage revealed a 1.0 cm nidus of abnormal vessels, which was supplied by a single feeder from the right posterior cerebral artery and drained by a single vein into the superior sagittal sinus, confirming the presence of an AVM [
The patient's intracerebral hemorrhage was managed conservatively and he was discharged with minor deficit (left inferior quadrantanopia). He opted to treat his AVM with gamma knife surgery which was scheduled 4 months after his initial presentation. However, the stereotactic digital subtraction angiography performed just before gamma knife surgery planning demonstrated absence of the AVM nidus and resolution of the network of abnormal draining vessels [
The classic belief that all AVMs are congenital lesions arising from vascular dysgenesis during early fetal development has been challenged.[
Spontaneous obliteration is defined as the disappearance of an AVM in the absence of any intervention or therapy.[
Current hypotheses for spontaneous AVM obliteration are centered on the interruption of arterial feeders and venous outflow occlusion. Compressive effects of mass lesions, such as intracerebral hematomas due to AVM rupture,[
Spontaneous obliteration of AVM is a rare but well-established phenomenon that bears testimony to the dynamics of this vascular disorder.
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Conflicts of interest
There are no conflicts of interest.
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