Recurrent Brain Arteriovenous Malformations (AVMs): A Systematic Review

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.