Last Updated: September 28, 2018
Failure to completely obliterate or resect an arteriovenous malformation (AVM) is not an exceedingly rare outcome following intervention, particularly with high-grade lesions that have significant nidal diffusivity. The altered but persistent aberrant flow dynamics within a partially obliterated AVM may cause an increased risk of hemorrhage compared with the lesion’s natural history/progression.
Aberration or changes in the angiographic appearance of the perinidal cerebrovascular anatomy require that the surgeon perform a formal digital subtraction angiography (DSA). DSA is the diagnostic “gold standard” and the best method to identify residual and recurrent AVMs.
Following resection, imaging is necessary to document complete resection and record the baseline angiographic results. I routinely perform an intraoperative DSA to confirm complete resection. I also obtain a postoperative DSA because the intraoperative DSA occasionally fails to show a small residual AVM or an AVM compartment that becomes apparent on angiography only some time after resection of its main component.