1229. Surgical management of cerebral AVMs ; our experiences in Bir Hospital, Kathmandu

Authors: Gopal Raman Sharma, MD, IFAANS (Kathmandu, Nepal)

Introduction: Cerebral arteriovenous malformations ( AVMs ) are one- seventh as common as cerebral aneurysms.50% of death of patients with cerebral AVMs are due to intraceebral hemorrhage.There are different modalities of treatment of cerebral AVMs that included microsurgery, radiosurgery and embolisation.In experienced hands best treatment option is microsurgical resection that usually makes the patients disease free immediately and prevents future bleeding. Aim of this study is to discuss the outcome of microsurgical resection of cerebral AVMs in our institute. Methods: This is a retrospective study of prospectively collected data of 36 patients who were operated for cerebral AVMs between November 2009 and December 20016. Follow up period ranged from 18 months to 7 years. Outcome was measured by GOS. Results: The male female ratio was 1:0.26 and mean age was 30. Thirty patients were presented with intracerebral hematoma, four patients with seizure and one patient was asymptomatic. on cerebral angiogram 2 patients had Spetzler- Martin grade I, 20 patients had grade II, 10 patients had grade III and 4 had grade IV. 33 AVMs were supratentorial and 3 infratentorial region. 20% developed postoperative complications. Favorable outcome after surgical excision was achieved in 86.6%, 13.4% were severely disabled and there was one mortality. Followed up Cerebral angiogram of all patients showed no residual AVMs. Conclusion: Surgical excision is the best treatment option for cerebral AVMs except giant AVMs which requires multimodality therapy.