Monitoring
Immediately post-operatively, patients should have close, frequent neurological assessment and cardiovascular monitoring. Cerebral perfusion of the surgical bed can be difficult to manage when there has been 'vascular steal' and loss of local autoregulation pre-operatively. Patients are at risk of ischaemia, hyperaemia, rebleeding, and seizures. Any change in neurological status should prompt a computed tomography scan.
Post-surgical resection
Patients should undergo early angiography to confirm complete resection. A delayed angiogram should be performed 3 to 6 months post-operatively to exclude any recanalisation.
There is a small risk of very late 'de novo' recurrence but this does not justify further routine surveillance.[26] Further angiography should be performed in the event of any further haemorrhagic events.
Post-stereotactic radiosurgery
Magnetic resonance imaging can be used to confirm that the arteriovenous malformation (AVM) has reduced in size, but angiography remains the standard to confirm complete obliteration.
Post-embolisation
There appears to be a 4.5% recurrence rate after embolisation of AVMs, so patients with obliterated AVMs need to be followed up with angiography at regular intervals.[70]
In patients with intracerebral haemorrhage (ICH) and a normal angiography but with a high index of suspicion of an AVM underlying a haematoma, a delayed angiogram (3-6 months after ICH, allowing for resolution of haematoma and decreased compression of underlying AVM) or superselective angiography of the vessels in the vicinity of the haematoma should be considered.[50][96]
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