The Latest Multimodal Treatment for Cerebral Arteriovenous Malformations

Abstract

  Decision-making for management of brain arteriovenous malformations (bAVM) is challenging owing to the diverse and rare clinical presentations. A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) study, which is the only randomized controlled trial to describe management of unruptured bAVM, has reported that medical management alone is superior to interventional therapy for prevention of death or stroke. However, recent studies have criticized the ARUBA trial with regard to its design, low enrollment rate, several biases, lack of subgroup analysis, and short follow-up, reviewing the ARUBA-eligible patients treated by interventional therapy to reconsider benefit of interventional therapy for unruptured bAVM. Japanese neurosurgeons should contribute to improvements in bAVM management through stratification of patients who are deemed suitable for interventional treatment and through establishment of novel interventional devices and skill enhancement.