title: Surgical removal after first bleeding of an arteriovenous malformation previously obliterated with radiosurgery: case report.
abstract: BACKGROUND
  Radiosurgery has been widely used to treat cerebral AVMs, providing angiographic evidence of obliteration of the malformation in 80% to 95% of patients, after a latency period of 2 to 5 years.
  
  
  METHODS
  We describe a case of hemorrhage, 6 years after radiosurgery and 4 years after complete angiographic obliteration of an AVM that had not previously bled and that persisted angiographically, obliterated after bleeding.
  
  
  RESULTS
  Several treatment options have been reported for patients with completely obliterated AVMs that bled, including conservative treatment, repeated radiosurgery, and open surgery with resection of AVM remnants. In the present case, the decision to perform surgery based on the probable association of the enhancing area observed on the MRI and the histologic findings was finally confirmed.
  
  
  CONCLUSIONS
  Magnetic resonance imaging enhancement areas on the obliterated AVMs may have a histopathologic correlation with persistence of permeable vessels and can be used as a guide for surgery and postoperative control. The follow-up of angiographically obliterated AVMs that bleed remains a matter of discussion twofold: regarding timing and use of a proper diagnostic test.
authors.affiliation: Department of Neurosurgery, Hospital La Fe Avda, 46009 Valencia, Spain. ricprat@ono.com
authors.forename: Ricardo
authors.initials: R
authors.lastname: Prat
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Galeano
authors.forename: Rebeca
authors.initials: R
authors.lastname: Conde
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Simal
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cárdenas
mesh_terms: D000328:Adult; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D016634:Radiosurgery; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed