Introduction: Despite the findings of the ARUBA trial, the optimal management of unruptured cerebral AVMs remains unclear. Current interventions to treat cerebral AVMs include microsurgery, radiosurgery, and embolization, with a goal of complete obliteration while minimizing complications. We conducted this study to determine the risk of stroke and death as well as long-term complications in ARUBA-eligible AVM patients following invasive interventions.
Methods: Retrospective analysis was performed on 673 patients with cerebral AVMs who were treated at the Cleveland Clinic between 2007 and 2014. Of the 673 patients, 105 were ARUBA-eligible. Mean follow-up period was 56 months (range 4-136 months). The primary outcome is the composite of stroke and death. Secondary complications recorded include hydrocephalus, cerebral edema, cysts, meningocele, CSF leakage, infections, and seizures.
Results: Of the 105 ARUBA-eligible patients, 44 (42%) patients had microsurgery as the final intervention and 61 (58%) patients had Gamma Knife as the final intervention. Of the 44 patients that had microsurgery as the final intervention, 5 (11.4%) patients had a stroke or died, 3 (6.8%) was complicated by infection, 2 (4.5%) developed hydrocephalus, 1 (2.3%) develop cerebral edema, 2 (4.5%) had CSF leakage, 1 (2.3%) developed psychosis, 2 (4.5%) developed meningocele, and 5 of the 15 patients with a history of seizures continued to have seizures. Of the 61 patients that had Gamma Knife as the final intervention, 3 (4.9%) had a stroke or died, 6 (9.8%) developed cerebral edema, 1 (1.6%) developed cerebral cyst, 3 (4.9%) developed hydrocephalus, and 8 of the 20 patients with a history of seizure continued to have seizures. 3 (4.9%) patients treated by Gamma Knife and 4 (9.1%) patients treated by microsurgery who did not have a history of seizures developed seizures follow intervention.
Conclusion: We report a lower rate of stroke or death, 7.6%, in our ARUBA-eligible patients population than the ARUBA-trial itself. However, there are potential complications associated with each intervention of AVMs and these should be taken into consideration prior to treatment. Further investigation is required to establish the standard of care for patients with unruptured cerebral AVM.