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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 355-362
DOI: 10.4103/ajns.AJNS_509_20
Original Article

Retrospective study and outcome predictor after microsurgical resection of cerebral arteriovenous malformations in Nepal

Prasanna Karki
Department of Neurosciences, Division of Neurosurgery, Nepal Mediciti Hospital, Lalitpur, Kathmandu
,
Gopal Sharma
Department of Neurosciences, Division of Neurosurgery, Nepal Mediciti Hospital, Lalitpur, Kathmandu
,
Sumit Joshi
Department of Neurosciences, Division of Neurosurgery, Nepal Mediciti Hospital, Lalitpur, Kathmandu
,
Prakash Paudel
Department of Neurosciences, Division of Neurosurgery, Nepal Mediciti Hospital, Lalitpur, Kathmandu
,
Damber Shah
Department of Neurosciences, Division of Neurosurgery, Nepal Mediciti Hospital, Lalitpur, Kathmandu
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Objective: The purpose of this study is to assess demographic, clinical, and morphological characteristics of patients with brain arteriovenous malformations (bAVMs). The relation of outcome using modified Ranklin Scale (mRS) at time of discharge, early and last follow ups with respect to various factors. Materials and Methods: Demographic data, arteriovenous malformation characteristics, and treatment outcomes were evaluated in 43 bAVMs treated with microsurgery between 2009 and 2019. For this series, 43 patients were retrospectively reviewed. A subgroup analysis for Spetzler-Martin grades (SMG) I/II, III, IV/V and III–V were performed. The mRS was used to assess functional outcomes. Results: Overall, mean age at diagnosis was 33 years (standard deviation = 19). Transient deficit, mRS deterioration and impaired functional outcome occurred less frequently in SMG I–II patients compared with Grade III–V patients combined (29% vs. 32% respectively, P = 0.00). All patients with SMG Grade I, Supplemented SMG Grade 2, 3, 4 and 6 had a mRS score of 2 or less at the last follow-up. Age was the only significant predictor of overall outcome after bAVM surgery on Chi-square test (P = 0.046), i.e: all patients <20 years had mRS score of 2 or less on last follow-up. Unfavorable outcome (mRS score of 3 or more than 3) level increased with higher grades in SMG on long term follow-up. Conclusion: The results of our case series of bAVM with SMG Grade I and Suplemented Grade 2, 3, 4 and even higher grade i.e., 6 can have excellent overall outcome after microsurgical resection. Association of factors which increases the grading system of bAVM like eloquence, deep venous drainage and increasing sizes did not correlate with the predicted unfavorable outcomes, whereas age of patients was a predictor of overall outcome. Although the small sample size of this study is a limitation, age of patient plays important role on the overall outcome.

Key-words:

Arteriovenous malformations - brain arteriovenous malformation - functional outcome - microsurgery - Spetzler-Martin grades

Financial support and sponsorship

Nil.




Publication History

Received: 26 November 2020

Accepted: 03 February 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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