Monitoring
Immediately postoperatively, patients should have close, frequent neurologic 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 preoperatively. Patients are at risk of ischemia, hyperemia, rebleeding, and seizures. Any change in neurologic status should prompt a computed tomography scan.
Postsurgical resection
Patients should undergo early angiography to confirm complete resection. A delayed angiogram should be performed 3 to 6 months postoperatively to exclude any recanalization.
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 hemorrhagic 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-embolization
There appears to be a 4.5% recurrence rate after embolization of AVMs, so patients with obliterated AVMs need to be followed up with angiography at regular intervals.[70]
In patients with intracerebral hemorrhage (ICH) and a normal angiography but with a high index of suspicion of an AVM underlying a hematoma, a delayed angiogram (3-6 months after ICH, allowing for resolution of hematoma and decreased compression of underlying AVM) or superselective angiography of the vessels in the vicinity of the hematoma should be considered.[50][97]
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