Unruptured cerebral arteriovenous malformations are better off treated medically: the ARUBA trial

A cerebral arteriovenous malformation (AVM) is an abnormal set of direct connections between the arteries and veins in the brain. These can cause a variety of neurologic symptoms, especially if they are large, and especially if they rupture.

Vein_of_galen_ax_direct_AV
arteriovenous malformation in the great cerebral vein of Galen; from Wikipedia user Filip em via Dr Laughlin Dawes

Mohr et al. recently published the result of the ARUBA trial, which compared medical (i.e., medical treatment for symptoms as needed) to interventional (i.e., surgical) treatment of this condition.

Their intention-to-treat analysis favored event-free survival in the medical management (MM; red) group:

Screen Shot 2017-09-13 at 8.25.31 AM
Mohr et al 2017; doi: 10.1212/WNL.0000000000004532

The actually-treated analysis favored event-free survival in the medical management (MM) group even more strongly:

Screen Shot 2017-09-13 at 8.30.04 AM
Mohr et al 2017; doi: 10.1212/WNL.0000000000004532

The authors suggest on the basis of this data that a reasonable management approach for unruptured cerebral AVM is to wait to see if a hemorrhage occurs, which may be mild if it does occur, and only then consider surgical intervention.