Stereotactic Radiosurgery for ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Spetzler-Martin Grade I and II Arteriovenous Malformations: A Multicenter Study.
OBJECTIVE
ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs.


METHODS
We pooled SRS data for patients with AVM from 7 institutions and selected ARUBA-eligible SM grade I-II AVMs with ≥12 months follow-up for analysis. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes.


RESULTS
The ARUBA-eligible SM grade I-II AVM cohort comprised 232 patients (mean age, 42 years). The mean nidus volume, SRS margin dose, and follow-up duration were 2.1 cm3, 22.5 Gy, and 90.5 months, respectively. The actuarial obliteration rates at 5 and 10 years were 72% and 87%, respectively; annual post-SRS hemorrhage rate was 1.0%; symptomatic and permanent radiation-induced changes occurred in 8% and 1%, respectively; and favorable outcome was achieved in 76%. Favorable outcome was significantly more likely in patients treated with a margin dose >20 Gy (83%) versus ≤20 Gy (62%; P < 0.001). Stroke or death occurred in 10% after SRS.


CONCLUSIONS
For ARUBA-eligible SM grade I-II AVMs, long-term SRS outcomes compare favorably with the natural history. SRS should be considered for adult patients harboring unruptured, previously untreated low-grade AVMs with a minimum life expectancy of a decade.
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Dale
D
Ding
Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA.
Robert M
RM
Starke
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Hideyuki
H
Kano
Division of Neurosurgery, Department of Neurosurgery, University of Sherbrooke, Centre de recherché du CHUS, Sherbrooke, Quebec, Canada.
David
D
Mathieu
Department of Neurosurgery, New York University, Langone Medical Center, New York, New York, USA.
Paul P
PP
Huang
Department of Neurosurgery, New York University, Langone Medical Center, New York, New York, USA.
Douglas
D
Kondziolka
Section of Neurosurgery, Department of Surgery, University of Puerto Rico, San Juan, Puerto Rico, USA.
Caleb
C
Feliciano
Section of Neurosurgery, Department of Surgery, University of Puerto Rico, San Juan, Puerto Rico, USA.
Rafael
R
Rodriguez-Mercado
Section of Neurosurgery, Department of Surgery, University of Puerto Rico, San Juan, Puerto Rico, USA.
Luis
L
Almodovar
Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA.
Inga S
IS
Grills
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Danilo
D
Silva
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Mahmoud
M
Abbassy
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Symeon
S
Missios
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Gene H
GH
Barnett
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
L Dade
LD
Lunsford
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jps2f@virginia.edu.
Jason P
JP
Sheehan
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000532:radiotherapy*; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
ARUBA; Intracranial arteriovenous malformation; Intracranial hemorrhages; Radiosurgery; Spetzler-Martin grade I and II; Stroke; Vascular malformations