Background/Objectives: Brain arteriovenous malformations (AVMs) are rare but clinically significant lesions associated with hemorrhage, seizures, and neurological deficits. Microsurgical resection remains the gold standard for low- and intermediate-grade AVMs, though treatment of unruptured AVMs is still debated. To present functional outcomes of microsurgical treatment for intracranial AVMs in a high-volume neurosurgical center. Methods: We retrospectively analyzed 111 patients who underwent microsurgical AVM resection between 2010 and 2022 at the Clinical Center of Serbia. Demographic, clinical, radiological, and surgical data were collected. Functional outcomes were assessed using the modified Rankin Scale (mRS) at discharge and after nine months. Results: The mean patient age was 36 years (range 8–75); 54 (48.6%) were male. AVMs were most often supratentorial (91.9%), located in the frontal (26.1%) and temporal lobes (19.8%). Hemorrhage was the presenting symptom in 53.2% of patients. Postoperative complications included hematoma (10.8%), meningitis (13.5%), and wound infection (8.1%). The mean mRS at discharge was 2.10, improving significantly to 1.15 at nine months (p < 0.001). Favorable outcome (mRS ≤ 2) was achieved in 64.0% at discharge and 81.1% at nine months. Prognostic factors for poor outcome included AVM size larger than 6 cm, higher supplementary Spetzler–Martin grade, and combined venous drainage. Conclusions: Microsurgical resection provides an important component of multidisciplinary AVM management, especially in low- and selected intermediate-grade lesions, achieving favorable functional outcomes in the majority of patients. Careful patient selection, AVM grading, and venous drainage analysis remain essential for prognosis and treatment planning.

Introduction: The presence of syringomyelia associated with Dandy-Walker malformation is rarely described in adults. Case report: We report a case of a 28-year-old woman with a history of Dandy-Walker malformation who developed syringomyelia. She had been previously treated in childhood with a ventriculoperitoneal and cystoperitoneal shunt for hydrocephalus, but over time she developed progressive neurological symptoms, including numbness and weakness in the upper extremities. Magnetic resonance imaging revealed a syrinx extending from C4 to T1 associated with large posterior fossa cyst. The patient was treated with cyst fenestration and cystoperitoneal shunts were removed, with complete resolution of symptoms and disappearance of syrinx. Discussion: A literature review revealed only 6 cases of syringomyelia associated with Dandy-Walker malformation in adults. The pathophysiology of this entity is multifactorial and may be related to obstructed cerebrospinal fluid flow, altered pressure dynamics, and formation of arachnoid adhesions. Conclusions: Individualized surgical approaches are essential for optimizing outcomes in this rare condition. Further research is needed to standardize treatment protocols and clarify underlying mechanisms and help to improve the management of these patients.

Background and Objectives: brain arteriovenous malformations (AVMs) are a leading cause of spontaneous intracranial hemorrhage in children and carry a disproportionately high lifetime hemorrhagic risk. Materials and Methods: We retrospectively analyzed clinical, morphological, and surgical factors associated with functional outcome in 30 consecutive pediatric patients (≤18 years) who underwent microsurgical AVM resection at a single tertiary neurosurgical center between January 2015 and December 2025. Results: Functional status was assessed with the modified Rankin Scale (mRS) at hospital discharge and at 6–9 months of follow-up; the Wilcoxon signed-rank test, Mann–Whitney U test, Fisher’s exact test, Spearman correlation, and univariable logistic regression were used for analysis. Complete resection on early postoperative CT angiography was documented in all 30 patients (100%). The proportion with a favorable outcome (mRS 0–2) improved significantly from 50.0% at discharge to 76.7% at follow-up (p < 0.0001); 80.8% of survivors improved by at least one mRS point, and none deteriorated. In univariable analysis, the variable most strongly associated with poor outcome was intraventricular hemorrhage (IVH; odds ratio [OR] 28.5, 95% CI 2.65–306.6; p = 0.002); the wide confidence interval reflects the small number of events and precludes a precise estimate of effect size. Lower admission Glasgow Coma Scale (GCS) score (p = 0.0006), higher Supplemented Spetzler–Martin (S–M) grade (p = 0.019), and postoperative complications (p = 0.016) were likewise associated with poor outcome. Because these associations are univariable and unadjusted for confounding, they should be regarded as exploratory and hypothesis-generating rather than as independent predictors. All four deaths occurred in malformations in eloquent locations (p = 0.037). Microsurgical resection achieved complete resection on early postoperative CT angiography in all patients; however, functional recovery appeared to be associated primarily with the severity of the initial hemorrhagic insult—particularly IVH—and with lesion complexity rather than with the achievement of angiographic resection alone. Conclusions: Given the small, surgically selected cohort and the limited follow-up, these findings require confirmation in larger multicenter studies.

Background and Objectives: The management of unruptured brain arteriovenous malformations (ubAVMs) remains controversial, particularly following the ARUBA trial, which favored conservative management. However, concerns regarding the validity of its findings persist. This study aimed to evaluate the outcomes of microsurgical resection of ubAVMs in a high-volume neurosurgical center. Materials and Methods: This is a retrospective single-center study that analyzed 52 patients treated by microsurgical resection at the Cerebrovascular Department, University Clinical Center of Serbia, between January 2010 and January 2022. All patients were classified according to the supplementary Spetzler–Martin (suppl-SM) grading system and stratified into low-risk (suppl-SM ≤ 6) and high-risk (suppl-SM > 6) groups. Functional outcomes were assessed using the modified Rankin Scale (mRS) at discharge and 9-month follow-up. Results: The mean patient age was 38.8 years, with equal gender distribution. Epileptic seizure was the most common presenting symptom (80.4%). In the low-risk group, there were no deaths, and poor outcomes were rare (6.8% at discharge; 2.3% at 9 months). Conversely, the high-risk group demonstrated significantly worse outcomes (62.5% poor outcome at discharge, 28.6% at 9 months). The overall hemorrhagic stroke rate was 5.8%, with one fatality (12.5%) in the high-risk subgroup. Absence of superficial venous drainage and presence of combined/deep venous drainage were strongly associated with poor outcomes. Conclusions: Microsurgical resection of ubAVMs is a safe and effective treatment strategy for low-grade lesions, yielding excellent functional outcomes and minimal morbidity. Our findings, supported by other large series, reinforce microsurgery as the gold standard for low-grade ubAVMs in appropriately selected patients.