Early regrowth of juvenile cerebral arteriovenous malformations: report of 3 cases and immunohistochemical analysis

Takagi, Yasushi; Kikuta, Ken-ichiro; Nozaki, Kazuhiko; Hashimoto, Nobuo

doi:10.1016/j.surneu.2009.07.008

« Previous Next »World Neurosurgery
Volume 73, Issue 2 , Pages 100-107, February 2010

Early regrowth of juvenile cerebral arteriovenous malformations: report of 3 cases and immunohistochemical analysis

Yasushi Takagi, MD, PhD
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto 606-8507, Japan
- Corresponding author. Department of Neurosurgery, Kyoto University Hospital, Sakyo-ku, Kyoto 606-8507, Japan. Tel.: +81 75 751 3459; fax: +81 75 752 9501.
Ken-ichiro Kikuta, MD, PhD
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto 606-8507, Japan
- Department of Neurosurgery, School of Medicine, Fukui University, Fukui 910-1193, Japan
Kazuhiko Nozaki, MD, PhD
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto 606-8507, Japan
- Department of Neurosurgery, Shiga Medical University, Ohtsu 520-2192, Japan
Nobuo Hashimoto, MD, PhD
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto 606-8507, Japan
- National Cardiovascular Center, Suita 565-8565, Japan

Received 12 June 2009; accepted 3 July 2009. published online 15 October 2009.

Abstract

Background

Regrowth of cerebral AVMs after angiographically documented obliteration has been observed in children. In addition, AVMs in adults are reported to be at risk of regrowth despite an angiogram confirming complete removal. However, the mechanism by which regrowth occurs has not been clarified; neither is it clear when regrowth occurs after removal.

Case Description

We report 3 cases showing regrowth of AVMs on postoperative angiogram performed 3 months after surgery. We also analyzed the protein levels of various factors that may influence AVM regrowth. Using immunohistochemistry, we analyzed the protein levels of the following factors: CD31 (PECAM), CD34, and CD105 (endoglin), which are endothelial or endothelial progenitor markers; VEGF, a growth factor that may influence AVM regrowth; and PCNA, a marker of proliferating cells. In addition, we analyzed the level of pERK.

Conclusion

We report 3 cases of early regrowth of cerebral AVMs. In recurrent AVM samples obtained at second operations, increased levels of perivascular CD105 and pERK immunoreactivity were seen.

Abbreviations: A-V, arteriovenous, AVM, arteriovenous malformation, IgG, immunoglobulin G, PBS, phosphate-buffered saline, PCNA, proliferating cell nuclear antigen, PECAM, platelet endothelial cell adhesion molecule, pERK, phosphorylated extracellular signal–regulated kinase, S-M, Spetzler and Martin, TGF, transforming growth factor, VEGF, vascular endothelial growth factor