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Background: Clinical 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. Methods: The 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. Results: Out 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. Conclusion: The 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.

Introduction: The establishment of local neurosurgery training programs in Nepal has proven critical for the expansion of the discipline across the country. This paper aims to describe the evolution, current status, challenges, and future directions of academic neurosurgery in Nepal. Research question: What is the current status and international standing of academic neurosurgery in Nepal? Material and methods: Information related to growth and development in Nepal was obtained from universities and regulatory bodies in Nepal. Variables described are the current number of neurosurgeons, the number of neurosurgical centers and centers with accreditation for training, the description of existing training models, the number of graduates, and the contribution of Nepalese neurosurgeons to world literature. Results: Formal neurosurgical training started in Nepal in 1999. Of 67 hospitals with neurosurgical facilities, 10 (14.9%) are accredited. Three training models (MCh, NBMS, and FCPS) currently exist. Of 116 neurosurgeons currently practicing in the country, 47 (40.5%) are homegrown. The contribution of the Nepalese neurosurgical community to the world includes the training of the first two Maldivian neurosurgeons and an increasing presence in world neurosurgical literature. Conclusions: Although comparable to other countries with similar economies, Nepal still faces some challenges to the sustainability and further developments of Neurosurgery. Continued concerted efforts will help Nepalese neurosurgeons achieve the goal of securing self-reliance in neurosurgical education.