Invasive treatment of unruptured brain arteriovenous malformations is experimental therapy

• Published in: Current opinion in neurology Vol. 19; no. 1; p. 63
• Main Authors: Stapf, Christian, Mohr, Jay P, Choi, Jae H, Hartmann, Andreas, Mast, Henning
• Format: Journal Article
• Language: English
• Published: England 01.02.2006
• Subjects: Brain - blood supply; Brain - physiopathology; Brain - surgery; Cerebral Arteries - abnormalities; Cerebral Arteries - physiopathology; Cerebral Arteries - surgery; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - physiopathology; Cerebral Hemorrhage - prevention & control; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - standards; Embolization, Therapeutic - trends; Humans; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - physiopathology; Intracranial Arteriovenous Malformations - surgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - standards; Neurosurgical Procedures - trends; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - physiopathology; Postoperative Hemorrhage - prevention & control; Risk Assessment; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - standards; Vascular Surgical Procedures - trends
• ISSN: 1350-7540
• DOI: 10.1097/01.wco.0000200546.14668.78

Brain arteriovenous malformations (AVMs) are currently being treated in a variety of ways, including medical management, endovascular procedures, neurosurgery and radiotherapy. The widespread diffusion of these various treatment approaches is partially driven by the existence of variations in the perception about the risks of rupture, and how devastating such events would be. Data from the most recent studies suggest the majority of AVM patients are diagnosed without signs of hemorrhage, further, that the natural history risk for the unruptured cohort is far more benign than for those presenting with rupture. In cases where hemorrhage occurs, the clinical syndrome is significantly less disabling than in patients with non-AVM related hemorrhage. For unruptured AVMs, current morbidity data suggest a higher risk for invasive management than for the natural history of untreated patients. No randomized clinical trial data exist on the benefit of invasive AVM treatment, and the most contentious issue at present is whether intervention should be considered for AVMs that have not bled. In a scientific sense, invasive treatment for unruptured brain AVMs may be considered experimental therapy awaiting the results from 'A Randomized Trial of Unruptured Brain AVMs' (ARUBA), which is currently underway.