title: Treatment outcomes of unruptured arteriovenous malformations with a subgroup analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible patients.
abstract: BACKGROUND
  The design and conclusions of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial are controversial, and its structure limits analysis of patients who could potentially benefit from treatment.
  
  
  OBJECTIVE
  To analyze the results of a consecutive series of patients with unruptured brain arteriovenous malformations (BAVMs), including a subgroup analysis of ARUBA-eligible patients.
  
  
  METHODS
  One hundred five patients with unruptured BAVMs were treated over an 8-year period. From this series, 90 adult patients and a subgroup of 61 patients determined to be ARUBA eligible were retrospectively reviewed. A subgroup analysis for Spetzler-Martin grades I/II, III, and IV/V was performed. The modified Rankin Scale was used to assess functional outcome.
  
  
  RESULTS
  Persistent deficits, modified Rankin Scale score deterioration, and impaired functional outcome occurred less frequently in ARUBA-eligible grade I/II patients compared with grade III to V patients combined (P = .04, P = .04, P = .03, respectively). Twenty-two of 39 patients (56%) unruptured grade I and II BAVMs were treated with surgery without and with preoperative embolization, and all had a modified Rankin Scale score of 0 to 1 at the last follow-up. All patients treated with surgery without and with preoperative embolization had radiographic cure at the last follow-up.
  
  
  CONCLUSIONS
  The results of ARUBA-eligible and unruptured grade I/II patients overall show that excellent outcomes can be obtained in this subgroup of patients, especially with surgical management. Functional outcomes for ARUBA-eligible patients were similar to those of patients who were randomized to medical management in ARUBA. On the basis of these data, in appropriately selected patients, we recommend treatment for low-grade BAVMs.
authors: *Department of Neurological Surgery, ‡Radiology, and §Radiation Oncology, University of Washington, Seattle, Washington.
authors: John D
authors: JD
authors: Nerva
authors: Alessandra
authors: A
authors: Mantovani
authors: Jason
authors: J
authors: Barber
authors: Louis J
authors: LJ
authors: Kim
authors: Jason K
authors: JK
authors: Rockhill
authors: Danial K
authors: DK
authors: Hallam
authors: Basavaraj V
authors: BV
authors: Ghodke
authors: Laligam N
authors: LN
authors: Sekhar
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D018579:Patient Selection; D016634:Radiosurgery; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome