Journal article
Intervention for A randomized trial of unruptured brain arteriovenous malformations (ARUBA) — Eligible patients: An evidence-based review
Clinical neurology and neurosurgery, Vol.150, pp.133-138
11/2016
DOI: 10.1016/j.clineuro.2016.09.007
PMID: 27656780
Abstract
•The role of intervention in unruptured AVMs remains unclear.•ARUBA concluded that medical therapy was superior to intervention for treatment of unruptured AVMs.•Subsequent studies of ARUBA-eligible patients have challenged the role of medical therapy alone.•Future randomized trials reflecting current interventional practices are warranted and forthcoming.
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.
Details
- Title: Subtitle
- Intervention for A randomized trial of unruptured brain arteriovenous malformations (ARUBA) — Eligible patients: An evidence-based review
- Creators
- Christopher S Hong - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USAEric C Peterson - Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USADale Ding - Department of Neurosurgery, University of Virginia, Charlottesville, VA, USASamir Sur - Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USADavid Hasan - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USAAaron S Dumont - Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USANohra Chalouhi - Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USAPascal Jabbour - Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USARobert M Starke - Department of Neurological Surgery, Miami Miller School of Medicine, Miami, FL, USA
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.150, pp.133-138
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.clineuro.2016.09.007
- PMID
- 27656780
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Language
- English
- Date published
- 11/2016
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040011902771
Metrics
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