Symptomatic de novo arteriovenous malformation appearing 17 years after the resection of two other arteriovenous malformations in childhood: case report

OBJECTIVE AND IMPORTANCE: This report describes the first case of symptomatic de novo arteriovenous malformation (AVM) appearing ectopically after total resection of other AVMs. We discuss the growth phenomenon and the nature of AVMs. CLINICAL PRESENTATION: A 27-year-old woman with sudden headache and right-sided numbness was admitted to our hospital. Computed tomographic scans revealed a hemorrhage of the corpus callosum and the bilateral lateral ventricles. A cerebral angiogram demonstrated an AVM that was fed by the bilateral pericallosal arteries and drained into the inferior sagittal sinus. Seventeen years earlier, at the age of 10 years, the patient had undergone resection of two other AVMs. At that time, the newly presented AVM was not detected. This AVM had grown markedly and caused hemorrhage after 17 years. INTERVENTION: The AVM, which was located in the bilateral cingulate gyrus and the corpus callosum, was totally removed through a right frontal craniotomy. The patient was discharged without neurological deficits. CONCLUSION: Our findings suggest that patients who undergo complete resection of AVMs may sustain other de novo AVMs some years later. The growth of an AVM seems to be related to the patient's age at onset and the duration of the posttreatment period. We emphasize the importance of long-term follow-up in patients with cerebral AVMs treated during childhood.