ARUBA Results Are Not Applicable to All Patients With Arteriovenous Malformation
A 25-year-old woman presents with right-sided headaches. Brain MRI reveals a superficial 4-cm right parietal arteriovenous malformation without evidence of previous hemorrhage (Spetzler–Martin grade 3).
Should she be referred for neurosurgery or endovascular treatment?
Is endovascular treatment superior to medical treatment in this patient?
Are the results of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial applicable to all arteriovenous malformation patients?
For brain arteriovenous malformations (AVMs), rupture represents the primary concern. Both prospective and retrospective observational studies have helped to define the natural history of AVMs and highlight potential risk factors. Estimates for bleeding from unruptured AVMs range from 1.3% to 4% per year1,2 with mortality of 10% to 30% from incident hemorrhage and neurological disability of 20% to 30%. Angioarchitectural features (eg, intranidal aneurysms, exclusive deep drainage, and restricted venous outflow), lesional features (eg, small size and deep location), and patient-specific features (eg, age, seizure history, and pregnancy) have all been described as affecting the rupture risk.
The efficacy and risk of treatment vary based on the modality used (surgical, endovascular, or radiosurgical) and AVM specific location and features. For surgical treatment, the most robust risk stratification is based on the Spetzler–Martin …