Microsurgery for ARUBA Trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation)–Eligible Unruptured Brain Arteriovenous Malformations

Abstract

Background and Purpose-The management of unruptured brain arteriovenous malformations (ubAVMs) remains controversial despite ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation), a controlled trial that suggested superiority of conservative management over intervention. However, microsurgery occurred in only 14.9% of ARUBA intervention cases, raising concerns about the study's generalizability. Our purpose was to evaluate whether, in a larger ARUBA-eligible ubAVM population, microsurgery produces acceptable outcomes. Methods-Demographic data, AVM characteristics, and treatment outcomes were evaluated in 155 ARUBA-eligible bAVMs treated with microsurgery between 1994 and 2014. Outcomes were rates of early disabling deficits and permanent disabling deficits with modified Rankin Scale score ≥3 or any permanent neurological deficits with modified Rankin Scale score ≥1. Covariates associated with outcomes were determined by regression analysis. Results-Of

Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

“…12 Hence the supposed negative impact of surgery on the outcome of unruptured AVMs is certainly not generalizable. 24 Moreover, the reported complication rates of any treatment were higher than expected; these are very different results from those previously reported in other cohorts [24][25][26][27][28][29][30] and were not explained by the ARUBA investigators. Furthermore, no data on obliteration rates were provided.…”

Risk factors for hemorrhage of brain arteriovenous malformation

“…This study found that among patients aged 16 years or older, the conservative management was associated with better clinical outcomes for up to 12 years compared with intervention . Numerous centers have since reported superior safety profiles with treatment . The optimal treatment remains controversial.…”

“…113 Numerous centers have since reported superior safety profiles with treatment. [114][115][116][117][118][119][120] The optimal treatment remains controversial.…”

“Dirty coagulation” technique as an alternative to microclips for control of bleeding from deep feeders during brain arteriovenous malformation surgery

“…Despite the fact that we did not encounter haemorrhagic complications related to the application of Bdirty coagulation^technique, our series is relatively small and does not allow us to make an unambiguous statement about the effectiveness of the method. Perioperative bleeding complications after surgical treatment vary from 0 to 12.8% in different series [4,5,15]. As we analysed only cases with available high-definition quality videos, our series included only 35 cases that were performed during the last 5 years.…”