Outcomes of Microsurgical Resection of Low-Grade Cerebral Arteriovenous Malformations: A Prospective Observational Multicenter Study from a Low-Middle-Income Country

Abstract

Objective: To appraise the overall outcomes of microsurgical resection of low-grade arteriovenous malformations (AVMs) in a low-middle-income country. Methods: Data was collected prospectively from three different neurosurgical centres in Pakistan for this study and it lasted for two years. According to the Spetzler-Martin (S-M) grading system, patients diagnosed with cerebral AVMs were divided into three classes A, B, and C. AVMs of grade 1 and 2 were included in Class A. Class B contained grade 3 AVMs, while Class C contained grade 4 and 5 AVMs. All male and female patients in Class A were eligible for this study. Patients were evaluated postoperatively for seizures, haemorrhage, focal neurological deficits, and AVM cure rates. Morbidity, mortality, and functional recovery were used to evaluate the outcome. Functional recovery and cure rate were observed after 6 months of follow-up. Results: There were a total of 22 patients. Mean age was 36.41 ± 14.32 SD years. There were 12 (54.5 %) male patients and 10 (45.5 %) female patients. 13 patients (59.1 %) presented with spontaneous intracerebral haemorrhage, while 9 patients (40.9 %) presented with seizures. 14 patients (63.6 %) had S-M grade 1 and 8 patients (36.4 %) had S-M grade 2. All patients underwent microsurgical resection. We discovered 4.5 % morbidity in our study. There was no postoperative mortality. At 6 months, an excellent functional outcome of 95.5 % (according to the Glasgow outcome scale) and 100 % cure rate was observed. Conclusion: Microsurgery is a safe and effective treatment for low-grade AVMs in terms of morbidity, mortality, functional outcome and cure rates in our country.

Keywords

• AVM
• Microsurgery
• Neurosurgery
• Multicenter study
• Observational study
• Developing countries