Invasive treatment of unruptured brain arteriovenous malformations is experimental therapy.
OBJECTIVE
Brain arteriovenous malformations (AVMs) are currently being treated in a variety of ways, including medical management, endovascular procedures, neurosurgery and radiotherapy. The widespread diffusion of these various treatment approaches is partially driven by the existence of variations in the perception about the risks of rupture, and how devastating such events would be.


RESULTS
Data from the most recent studies suggest the majority of AVM patients are diagnosed without signs of hemorrhage, further, that the natural history risk for the unruptured cohort is far more benign than for those presenting with rupture. In cases where hemorrhage occurs, the clinical syndrome is significantly less disabling than in patients with non-AVM related hemorrhage. For unruptured AVMs, current morbidity data suggest a higher risk for invasive management than for the natural history of untreated patients.


CONCLUSIONS
No randomized clinical trial data exist on the benefit of invasive AVM treatment, and the most contentious issue at present is whether intervention should be considered for AVMs that have not bled. In a scientific sense, invasive treatment for unruptured brain AVMs may be considered experimental therapy awaiting the results from 'A Randomized Trial of Unruptured Brain AVMs' (ARUBA), which is currently underway.
Stapf
Christian
C
Stroke Center/The Neurological Institute, Columbia University, New York, NY, USA. christian.stapf@lrb.aphp.fr
Mohr
Jay P
JP
Choi
Jae H
JH
Hartmann
Andreas
A
Mast
Henning
H
D001921:Brain / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D002536:Cerebral Arteries / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000592:standards / Q000639:trends; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000592:standards / Q000639:trends; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000592:standards / Q000639:trends