ИСТИНА

Abstract Object. The aim of this study was to analyze surgical results and complications for unruptured brain arteriovenous malformations (uAVMs) to re-evaluate indications for surgery. Мethods. The retrospective analysis of early postoperative (10-14 day after surgery) outcomes for patients with uAVMs treated in Burdenko Neurosurgical Centre in 2009 – 2016 was performed. Study included adult (>18 years) patients harboring brain AVM admitted for microsurgery. Ruptured AVMs (based on MRI or CT evaluation) were excluded. Overall 141 patients were included in the study (57% males, 43% females). Mean age -33,1 years old (18 – 59). AVM manifested with seizures in 89 (62,7%) pt., headaches in 43 (30,3 %) pt., ischemic (steal) symptoms in 4 (2,8%) pt. and become an incidental finding in 5 (3,5%) cases. Results. Surgery risks were estimated with Spezler-Martin (S-M) scale: I grade – 18 (12,7%) pt., II grade – 63 (44,7%) pt., III grade – 51 (36,2%) pt., IV grade – 9 (6,4%) pt. High risk AVMs (S-M=V) were treated with other methods and were not included to the study. The best outcome were achieved in a “low-grade” (S-M= I-II) AVMs: 100% of grade I and 98,4% of grade II patients were discharged with GOS=4-5 score. Good results were obtained for more difficult cases as well: 82,3% for Grade III and 88,8% for Grade IV patients. Better Grade IV outcomes might be attributed to a smaller group. Overall, favorite outcomes comprised 92,2 % cases post-op. Mostly often complications were visual defects (74,3%). 2 patients were dead (1,4%). Conclusions. Microsurgery for patients with brain uAVMs proves to remain a beneficial treatment modality in carefully selected patients.