Introduction. Arteriovenous malformations in 2022: a state of the art

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  • 1 Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington;
  • | 2 Department of Neurosurgery at Kantonsspital St. Gallen, St. Gallen, Switzerland;
  • | 3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
  • | 4 Department of Neurosurgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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More than any other disease entity in cerebrovascular surgery, brain arteriovenous malformations (AVMs) remain shrouded in management complexity and confusion. Part of this comes from our rudimentary understanding of AVM pathogenesis, as well as its variations in natural history based on presentation, high-risk features, and angioarchitecture. Part of this comes from the myriad treatment options with differential rates of cure and complications. Perhaps more than any other study in the AVM literature, one study has created significant confusion and polarizing interpretations. The ARUBA trial,1 published in 2014, randomly assigned 226 patients to receive observation or intervention. Despite controversy about the study’s design and results, ARUBA is hardly a meaningless trial. It has reminded clinicians that patient outcome should and must remain at the focus of treatment management, which was subject to variability and treatment bias in the years prior to the publication of ARUBA. This trial has galvanized the international neurosurgical community to look long and hard at outcomes data and reimagine the best ways to tackle difficult-to-treat AVMs. In this issue, we present a cadre of articles that continue to advance our understanding of the pathophysiology and management of AVMs. It is our hope that these studies will not only enlighten our readership but also inspire future AVM research and clinical trials that will continue to refine the neurosurgical treatment of this disease for the benefit of our patients.

Disclosures

Dr. Huang holds shares of Longeviti Neuro Solutions. Dr. Kim holds shares of SPI Surgical, LLC, and SPIWay, Inc.; and is a consultant for Philips North America and BP Advisors, LLC. Dr. Lanzino is a consultant for Nested Knowledge and Superior Medical Editors.

References

1

Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614621.

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Illustration from Agosti et al. (E5). Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.

  • 1

    Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614621.

    • Crossref
    • Search Google Scholar
    • Export Citation

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