Evidence map›Paper›PMID 25175446›Full record

ArticleNeurosurgical focus2014

Treatment and outcomes of ARUBA-eligible patients with unruptured brain arteriovenous malformations at a single institution.

W Caleb Rutledge, Adib A Abla, Jeffrey Nelson, Van V Halbach, Helen Kim, Michael T Lawton

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurosurgical focus, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Repeat radiosurgery for cerebral arteriovenous malformations.Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2015
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  20. Microsurgical Treatment of Deep and Eloquent AVMs.Advances and technical standards in neurosurgery · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

W Caleb RutledgeDepartment of Neurological Surgery, University of California, San Francisco.
Adib A Abla
Jeffrey Nelson
Van V Halbach
Helen Kim
Michael T Lawton

Funding

PREDICTORS OF SPONTANEOUS CEREBRAL AVM HEMORRHAGER01NS034949 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KIM, HELEN · 1995 to 2017
$6.5M
NINDS NIH HHS R01 NS034949
6 · The paper itself

Abstract

objectManagement of unruptured arteriovenous malformations (AVMs) is controversial. In the first randomized trial of unruptured AVMs (A Randomized Trial of Unruptured Brain Arteriovenous Malformations [ARUBA]), medically managed patients had a significantly lower risk of death or stroke and had better outcomes. The University of California, San Francisco (UCSF) was one of the participating ARUBA sites. While 473 patients were screened for eligibility, only 4 patients were enrolled in ARUBA. The purpose of this study is to report the treatment and outcomes of all ARUBA-eligible patients at UCSF.

methodsThe authors compared the treatment and outcomes of ARUBA-eligible patients using prospectively collected data from the UCSF brain AVM registry. Similar to ARUBA, they compared the rate of stroke or death in observed and treated patients and used the modified Rankin Scale to grade outcomes.

resultsOf 74 patients, 61 received an intervention and 13 were observed. Most treated patients had resection with or without preoperative embolization (43 [70.5%] of 61 patients). One of the 13 observed patients died after AVM hemorrhage. Nine of the 61 treated patients had a stroke or died. There was no significant difference in the rate of stroke or death (HR 1.34, 95% CI 0.12-14.53, p = 0.81) or clinical impairment (Fisher's exact test, p > 0.99) between observed and treated patients.

conclusionsThe risk of stroke or death and degree of clinical impairment among treated patients was lower than reported in ARUBA. The authors found no significant difference in outcomes between observed and treated ARUBA-eligible patients at UCSF. Results in ARUBA-eligible patients managed outside that trial led to an entirely different conclusion about AVM intervention, due to the primary role of surgery, judicious surgical selection with established outcome predictors, and technical expertise developed at high-volume AVM centers.

Indexed as

Embolization, TherapeuticRadiosurgeryAdolescentAdultAgedHumansIntracranial Arteriovenous MalformationsKaplan-Meier EstimateMagnetic Resonance AngiographyMagnetic Resonance ImagingMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesTomography Scanners, X-Ray ComputedTreatment Outcomearteriovenous malformationARUBAARUBA = A Randomized Trial of Unruptured Brain Arteriovenous MalformationsAVM = arteriovenous malformationmicrosurgical resectionmRS = modified Rankin ScaleobservationUCSF = University of California, San Francisco

Identifiers

PMID25175446
PMCPMC4420142

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.