Intervention for A randomized trial of unruptured brain arteriovenous malformations (ARUBA) - Eligible patients: An evidence-based review.

Journal Article (Journal Article;Review)

While intervention for ruptured arteriovenous malformations (AVMs) of the brain is typically warranted, the management of unruptured AVMs remains controversial. Despite numerous retrospective studies, only one randomized controlled trial has been conducted, comparing the role of medical management alone to medical management plus surgical and/or radiosurgical intervention in patients with unruptured AVMs: A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA). To great controversy, ARUBA concluded that medical management alone was superior to intervention for unruptured AVMs, which was subsequently challenged by various single-institution and multi-center studies analyzing outcomes of ARUBA-eligible patients. This review summarizes studies returned from a PubMed database search querying, 'ARUBA,' 'ARUBA-eligible,' 'surgery unruptured AVM,' and "radiosurgery unruptured AVM". The rates of the primary endpoint of symptomatic stroke or death were low among the analyzed studies (0-12.2%, mean 8.0%) and similar to the medically managed arm of ARUBA (10.1%). Likewise, the percentage of patients with impaired functional outcomes (modified Rankin score ≥2) in the reviewed studies was low (5.9%-13.1%; mean: 9.9%) and comparable to the 14.0% observed in the medically management arm of ARUBA. The key findings of ARUBA and subsequent work in its aftermath are overviewed and analyzed for the role of surgery and/or radiosurgery in patients with unruptured AVMs.

Full Text

Duke Authors

Cited Authors

  • Hong, CS; Peterson, EC; Ding, D; Sur, S; Hasan, D; Dumont, AS; Chalouhi, N; Jabbour, P; Starke, RM

Published Date

  • November 2016

Published In

Volume / Issue

  • 150 /

Start / End Page

  • 133 - 138

PubMed ID

  • 27656780

Electronic International Standard Serial Number (EISSN)

  • 1872-6968

Digital Object Identifier (DOI)

  • 10.1016/j.clineuro.2016.09.007

Language

  • eng

Conference Location

  • Netherlands