TY - JOUR
T1 - Stereotactic Radiosurgery for A Randomized Trial of Unruptured Brain Arteriovenous Malformations- Eligible Patients
T2 - A Meta-Analysis
AU - Ilyas, Adeel
AU - Chen, Ching Jen
AU - Abecassis, Isaac Josh
AU - Al-Saiegh, Fadi
AU - Ironside, Natasha
AU - Jabbour, Pascal M.
AU - Tjoumakaris, Stavropoula
AU - Gooch, M. Reid
AU - Lee, Cheng Chia
AU - Sheehan, Jason P.
AU - Ding, Dale
N1 - Publisher Copyright:
© 2022 Congress of Neurological Surgeons. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - BACKGROUND: The outcomes of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) were controversial, and they suggested that intervention is inferior to medical management for unruptured brain arteriovenous malformations (AVMs). However, several studies have shown that stereotactic radiosurgery (SRS) is an acceptable therapy for unruptured AVMs. OBJECTIVE: To test the hypothesis that ARUBA intervention arm's SRS results are meaningfully inferior to those from similar populations reported by other studies. METHODS: We performed a literature review to identify SRS studies of patients who met the eligibility criteria for ARUBA. Patient, AVM, treatment, and outcome data were extracted for statistical analysis. Regression analyses were pooled to identify factors associated with post-SRS obliteration and hemorrhage. RESULTS: The study cohort included 8 studies comprising 1620 ARUBA-eligible patients who underwent SRS. At the time of AVM diagnosis, 36% of patients were asymptomatic. The mean follow-up duration was 80 months. Rates of radiologic, symptomatic, and permanent radiation-induced changes were 45%, 11%, and 2%, respectively. The obliteration rate was 68% at last follow-up. The post-SRS hemorrhage and mortality rates were 8%, and 2%, respectively. Lower Spetzler-Martin grade (odds ratios [OR] = 0.84 [0.74-0.95], P =.005), lower radiosurgery-based AVM score (OR = 0.75 [0.64-0.95], P =.011), lower Virginia Radiosurgery AVM Scale (OR = 0.86 [0.78-0.95], P =.003), and higher margin dose (OR = 1.13 [1.02-1.25], P =.025) were associated with obliteration. CONCLUSION: SRS carries a favorable risk to benefit profile for appropriately selected ARUBA-eligible patients, particularly those with smaller volume AVMs. Our findings suggest that the results of ARUBA do not reflect the real-world safety and efficacy of SRS for unruptured AVMs.
AB - BACKGROUND: The outcomes of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) were controversial, and they suggested that intervention is inferior to medical management for unruptured brain arteriovenous malformations (AVMs). However, several studies have shown that stereotactic radiosurgery (SRS) is an acceptable therapy for unruptured AVMs. OBJECTIVE: To test the hypothesis that ARUBA intervention arm's SRS results are meaningfully inferior to those from similar populations reported by other studies. METHODS: We performed a literature review to identify SRS studies of patients who met the eligibility criteria for ARUBA. Patient, AVM, treatment, and outcome data were extracted for statistical analysis. Regression analyses were pooled to identify factors associated with post-SRS obliteration and hemorrhage. RESULTS: The study cohort included 8 studies comprising 1620 ARUBA-eligible patients who underwent SRS. At the time of AVM diagnosis, 36% of patients were asymptomatic. The mean follow-up duration was 80 months. Rates of radiologic, symptomatic, and permanent radiation-induced changes were 45%, 11%, and 2%, respectively. The obliteration rate was 68% at last follow-up. The post-SRS hemorrhage and mortality rates were 8%, and 2%, respectively. Lower Spetzler-Martin grade (odds ratios [OR] = 0.84 [0.74-0.95], P =.005), lower radiosurgery-based AVM score (OR = 0.75 [0.64-0.95], P =.011), lower Virginia Radiosurgery AVM Scale (OR = 0.86 [0.78-0.95], P =.003), and higher margin dose (OR = 1.13 [1.02-1.25], P =.025) were associated with obliteration. CONCLUSION: SRS carries a favorable risk to benefit profile for appropriately selected ARUBA-eligible patients, particularly those with smaller volume AVMs. Our findings suggest that the results of ARUBA do not reflect the real-world safety and efficacy of SRS for unruptured AVMs.
KW - ARUBA
KW - Brain arteriovenous malformation
KW - Intracranial hemorrhages
KW - Intracranial vascular malformations
KW - Radiosurgery
KW - Stroke
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UR - http://www.scopus.com/inward/citedby.url?scp=85140144961&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002115
DO - 10.1227/neu.0000000000002115
M3 - Article
C2 - 36001787
AN - SCOPUS:85140144961
SN - 0148-396X
VL - 91
SP - 684
EP - 692
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -