Unruptured cerebral arteriovenous malformation treatment

• Profiling Tight Junction Protein Expression in Brain Vascular Malformations
• Endovascular treatment of unruptured Spetzler-Martin grade IV and V brain AVMs in a predominantly Hispanic patient cohort
• Relationship of blood flow, angioarchitecture, and rupture in cerebral arteriovenous malformations
• Long-term outcomes and safety of Gamma Knife radiosurgery in pediatric arteriovenous malformations
• Symptomatic thrombosed venous aneurysm after stereotactic radiosurgery for brain arteriovenous malformation: Case report of a late complication mimicking radiation necrosis
• Risk factors for bleeding in patients with arteriovenous malformations associated with intracranial aneurysms
• Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients
• Comprehensive Management of a Giant Left Frontal AVM Coexisting with a Bilobed PComA Aneurysm: A Case Report Highlighting Multidisciplinary Strategies and Advanced Neurosurgical Techniques

see Unruptured cerebral arteriovenous malformation rupture risk.

The results of “A Randomized Trial of Unruptured Brain Arteriovenous Malformations” (ARUBA) suggested that observation alone resulted in less morbidity and mortality than intervention for these lesions. These findings generated significant controversy throughout the cerebrovascular community and resulted in several subsequent studies investigating the role of microsurgical resection on ARUBA-eligible patients ¹⁾.

The real-world evolution of management and outcomes of patients with unruptured brain arteriovenous malformations (AVMs) has not been well-delineated following the ARUBA trial findings of no general advantage of initial interventional (surgical/endovascular/radiotherapy) vs. initial conservative medical therapy. Nationwide practice in the management of unruptured AVMs changed substantially with the publication of the ARUBA trial in a durable and increasing manner. Fewer admissions with the interventional treatment of unruptured AVMs occurred, and a corresponding increase in admission for ruptured AVMs transpired, as expected with a strategy of watchful waiting and treatment only after an index bleeding event. Further studies are needed to determine whether these trends can be considered to be ARUBA trial effect or are merely coincidental ²⁾

Karlsson et al. in 2018 stated The ARUBA trial conclusion that medical management is superior to medical management with interventional therapy for all unruptured AVMs could be repudiated ³⁾.

A relatively benign natural course of unruptured cerebral arteriovenous malformations (AVMs) has been recognized, and the decision to treat incidentally found AVMs has been questioned.

The ARUBA trial showed that medical management alone is superior to medical management with endovascular treatment for the prevention of death or stroke in patients with unruptured brain arteriovenous malformations followed up for 33 months. The trial is continuing its observational phase to establish whether the disparities will persist over an additional 5 years of follow-up ⁴⁾.

Meling et al published that microsurgical resection of unruputured Spetzler Ponce classification A arteriovenous malformations is worthwhile and still the “gold standard” therapy ⁵⁾.