title: Intervention for A randomized trial of unruptured brain arteriovenous malformations (ARUBA) - Eligible patients: An evidence-based review.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hong
authors.affiliation: Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Sur
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.affiliation: Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USA. Electronic address: rstarke@med.miami.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
mesh_terms: D001164:Arteriovenous Fistula / Q000628:therapy*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
keywords: ARUBA; Arteriovenous malformation; Stereotactic radiosurgery; Unruptured