• Daniela de Souza Coelho, Fernandes de Oliveira SantosBrunoB1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and., Silva da CostaMarcos DevanirMD1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and., Gisele Sampaio Silva, Sergio Cavalheiro, Flávia H Santos, and Feres Chaddad-Neto.
• 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and.
• J. Neurosurg. 2020 May 1; 132 (5): 154815551548-1555.

ObjectiveA cerebral arteriovenous malformation (cAVM) can change over time and cause symptoms, but clinical studies tend to define only the patients with ruptured cAVMs as symptomatic and do not consider neurocognitive aspects prior to neurosurgical intervention. The objective of this study was to describe the neurocognitive function of patients with ruptured and unruptured cAVMs according to the Spetzler-Martin (SM) grade, flow status, and anatomical topography.MethodsIn this blinded cross-sectional study, 70 patients of both sexes and ages 18-60 years were evaluated using the Brazilian Brief Neuropsychological Assessment Battery Neupsilin.ResultsOf the 70 patients with cAVMs, 50 (71.4%) demonstrated deficits in at least one of the eight neurocognitive domains surveyed, although they did not exhibit neurological deficits. cAVMs in the temporal lobe were associated with memory deficits compared with the general population. The SM grade was not significantly associated with the results of patients with unruptured cAVMs. However, among patients with ruptured cAVMs, there were deficits in working memory in those with high-grade (SM grade) cAVMs and deficits in executive function (verbal fluency) in those with low-grade cAVMs (p < 0.001).ConclusionsThis study indicates that patients with untreated cAVMs, either ruptured or unruptured, already exhibit neurocognitive deficits, even the patients without other neurological symptoms. However, the scales used to evaluate disability in the main clinical studies, such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), do not assess neurocognitive alterations and therefore disregard any deficits that may affect quality of life. The authors' finding raises an important question about the effects of interventional treatment because it reinforces the hypothesis that cognitive alterations may be preexisting and not determined by interventions.

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