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.

This study evaluated participation outcomes one year after aneurysmal subarachnoid hemorrhage (aSAH) compared with matched healthy controls and identified factors associated with participation within the patient group. Forty aSAH survivors and seventy-five controls were assessed 12–14 months post-ictus. Participation was measured with the Utrecht Scale for Evaluation of Rehabilitation–Participation (USER-P), psychological distress with the Hospital Anxiety and Depression Scale (HADS), coping with the Brief COPE, and cognition with the Montreal Cognitive Assessment (MoCA). Compared with controls, patients reported greater participation restrictions (82 vs. 100, p < 0.001), lower frequency (35 vs. 51, p < 0.001), and reduced satisfaction (65 vs. 75, p < 0.001). Anxiety, depression, and avoidant coping independently predicted restrictions (adjusted R² = 0.48), while satisfaction was predicted by employment, fewer depressive symptoms, and less avoidant coping (adjusted R² = 0.52). Lower MoCA scores predicted reduced participation frequency (p = 0.032), and patients with cognitive impairment showed significantly greater restrictions and lower satisfaction. One year after aSAH, survivors experience substantial participation limitations associated with psychological distress, maladaptive coping, and cognitive deficits. These results underscore the importance of cognitive and psychological rehabilitation to enhance long-term participation and social reintegration after aSAH.

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.

Objectives: Survivors of mild-grade aneurysmal subarachnoid hemorrhage (aSAH) often achieve favorable neurological recovery, yet many continue to experience cognitive difficulties and reduced health-related quality of life (HRQoL). The relative contribution of objectively measured cognition and subjective cognitive complaints to long-term HRQoL in this population remains insufficiently clarified. Methods: This prospective cohort study assessed objective and subjective cognitive functioning one year after mild-grade aSAH (Hunt & Hess I–II) and examined their unique contributions to HRQoL. Forty endovascularly treated aSAH survivors and 80 neurologically healthy controls, matched for sex, age, and educational level, were assessed 12–14 months post-ictus using the Montreal Cognitive Assessment (MoCA), Cognitive Failures Questionnaire (CFQ), and SF-36. Results: Compared with controls, patients demonstrated significantly lower MoCA scores, with cognitive impairment present in 42.5% of cases, as well as reduced HRQoL. In multivariate regression analyses adjusted for demographic, clinical, and affective covariates, subjective cognitive complaints (CFQ) remained independently associated with the mental component summary score of the SF-36 (β = −0.47, p = 0.002). Objective cognitive performance (MoCA) was not associated with the SF-36 component summary scores but showed weaker, domain-specific associations in exploratory analyses. The correlation between MoCA and CFQ was weak (ρ = −0.33), indicating a dissociation between these two measures. Conclusions: One year after mild-grade aSAH, subjective cognitive complaints contribute to mental HRQoL above and beyond the influence of affective symptoms. These findings highlight a clinically relevant dissociation between perceived and objectively measured cognition and support the importance of incorporating patient-reported cognitive difficulties into long-term outcome assessment and rehabilitation planning.