ИСТИНА

Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons especially in the light of ARUBA and other observational studies. Presented retrospective study was aiming to analyze our experience with unruptured bAVMs to see whether it's beneficial long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009-2017. Mean age: 33,4±10years. Clinical presentation were: seizures in 99 (61.9%), chronical headaches - 49 (30.6%), ischemic symptoms - 4 (2.5%), asymptomatic in 8 (5%) patients. Spetzler-Martin scale: I- 18pt (11.3%), II - 71pt (44.4%), III - 60pt (37.5%), IV - 11pt (6.8%). Good outcomes (mRS=0-2) at discharge were achieved in 149 (93.1%), satisfactory (mRS - 3) - 9 (5.6%). Follow-up was complete for 101 (63.1%) patients, mean - 59.3 (13 - 108 month). Good outcomes (mRS=0-2) reached 97%. For epilepsy patients Engel I outcomes was found in 53 (85,5%), for chronic headaches - 44 (65,7%) patients reported improvement. Postoperative visual field defects were followed in 28 of 55 (51%), complete recovery was reported in 7 (25%) and partial - in 11 (39,3%) patients. All 4 patients with medio-basal AVMs had unchanged complete homonymous hemianopsia at follow-up, other occipital locations show better recovery potential. Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M I-II) is a beneficial, low-risk option. AVM resection is a quite effective treatment in seizures control (Engel class I). Treatment of headaches remains controversial and requires further study. Occipital medio-basal cortex is the most sensitive to damage area that causes permanent visual deficit after AVM surgery.