Clinical characteristics and outcome of patients with brain arteriovenous malformations from a university hospital in Nepal

Abstract

BackgroundClinical presentations, management strategies and outcomes of patients with brain arteriovenous malformations (bAVMs) are complex due to variable natural history and uncertainty in the optimal treatment modality. Data are scarce regarding patients with bAVMs from developing countries either due to low incidence or a low detection rate. The objective of this study is to describe the clinical characteristics, management strategies, and outcomes of patients with bAVMs treated microsurgically in a university hospital from Nepal. MethodsThe clinical records of patients confirmed to have bAVMs and microsurgically excised between July 2015 and March 2022 were retrospectively reviewed. Data on demographic and clinical characteristics, morphometric characteristics of bAVMs on imaging, management strategies, and the 6-month outcomes were abstracted and analyzed. ResultsOut of 43 bAVMs diagnosed, 23 were microsurgically excised during the study period. The mean age of the patients was 28 (7–57) years. Eighteen patients (78.2%) presented with hemorrhage whereas 5 (17.4%) had seizures. Eight (34.8&) patients had bAVMs on the motor cortex (6 on the right side and 2 on the left side). Only one patient had infratentorial bAVM. Seventeen (73.9%) out of 23 were in Spetzler-Martin grade II and III before surgery. One patient had flow-related two arterial aneurysms. A single-stage surgery was performed with angiographic confirmation of obliteration in all patients. The favorable outcome (mRS 0–2) was achieved in 22 (95.6%) patients. One patient died. ConclusionThe overall number of subjects diagnosed with bAVMs in our hospital is markedly lower than cerebral aneurysms. The resource limitation in the diagnosis due to the limited availability of computed tomography (CT), magnetic resonance imaging and angiography is the most likely cause of low detection. With an individualized and careful selection strategy, surgical results are excellent even in this low-volume setting.