Stereotactic Radiosurgery for ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)–Eligible Spetzler-Martin Grade I and II Arteriovenous Malformations: A Multicenter Study

Dale Ding, Robert M. Starke, Hideyuki Kano, David Mathieu, Paul P. Huang, Douglas Kondziolka, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S. Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H. Barnett, L. Dade Lunsford, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)507-517
Number of pages11
JournalWorld neurosurgery
Volume102
DOIs
StatePublished - Jun 1 2017

Keywords

  • ARUBA
  • Intracranial arteriovenous malformation
  • Intracranial hemorrhages
  • Radiosurgery
  • Spetzler-Martin grade I and II
  • Stroke
  • Vascular malformations

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Stereotactic Radiosurgery for ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)–Eligible Spetzler-Martin Grade I and II Arteriovenous Malformations: A Multicenter Study'. Together they form a unique fingerprint.

Cite this