ArticleNeurosurgery2019
The NASSAU (New ASSessment of cerebral Arteriovenous Malformations yet Unruptured) Analysis: Are the Results From The ARUBA Trial Also Applicable to Unruptured Arteriovenous Malformations Deemed Suitable for Gamma Knife Surgery?
Article in Neurosurgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- Treatments of unruptured brain arteriovenous malformations: A systematic review and meta-analysis.Medicine · 2021Pooled it
- Treatment Outcomes of Endovascular Embolization Only in Patients with Unruptured Brain Arteriovenous Malformations: A Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations).AJNR. American journal of neuroradiology · 2020Trial
- Obliteration Rate of Arteriovenous Malformation by Radiosurgery.The Malaysian journal of medical sciences : MJMS · 2025Article
- Interventional Treatment vs Conservative Management of Unruptured Brain Arteriovenous Malformations.JAMA network open · 2025Observational
- Natural history and clinical manifestation of Pediatric Brain Arteriovenous Malformations.Journal of Korean Neurosurgical Society · 2024Article
- Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery.Scientific reports · 2024Article
- National reduction in cerebral arteriovenous malformation treatment correlated with increased rupture incidence.Journal of neurointerventional surgery · 2023Article
- Multimodality treatment for brain arteriovenous malformation in Mainland China: design, rationale, and baseline patient characteristics of a nationwide multicenter prospective registry.Chinese neurosurgical journal · 2022Article
- Fatal ruptured occult arteriovenous malformation in a young adult: An autopsy case report.Surgical neurology international · 2022Article
- Microenvironment changes in arteriovenous malformations after stereotactic radiation.Frontiers in human neuroscience · 2022Review
- The 20th Gray lecture 2019: health and heavy ions.The British journal of radiology · 2020Review
- Updates in arteriovenous malformation management: the post-ARUBA era.Stroke and vascular neurology · 2020Review
- Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks.Therapeutics and clinical risk management · 2019Review
- Expert Consensus on the Management of Brain Arteriovenous Malformations.Asian journal of neurosurgeryReview
Corrections and comments
- Commented on by
Authors and funding
13 authors at 4 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal management of unruptured brain arteriovenous malformations (AVMs) is controversial after the ARUBA trial.
objectiveTo confirm or repudiate the ARUBA conclusion that "medical management only is superior to medical management with interventional therapy for unruptured brain arteriovenous malformations."
methodsData were collected from 1351 patients treated with Gamma Knife Surgery (GKS; Elekta AB, Stockholm, Sweden) for unruptured and untreated AVMs The follow-up was 8817 yr (median 5.0 and mean 6.5). The results of the analyses were compared to that found in patients randomized to medical management only in the ARUBA trial and extrapolated to a 10-yr time period. Our data were also compared to the natural course in a virtual AVM population for a 25-yr time period.
resultsThe incidence of stroke was similar among ARUBA and our patients for the first 5 yr. Thereafter, the longer the follow-up, the relatively better outcome following treatment. Both the mortality rate and the incidence of permanent deficits in patients with small AVMs were the same as in untreated patients for the first 2 to 3 yr after GKS, after which GKS patients did better. Patients with large AVMs had a higher incidence of neurological deficits in the first 3 yr following GKS. The difference decreased thereafter, but the time until break even depended on the analysis method used and the assumed risk for hemorrhage in patent AVMs.
conclusionThe ARUBA trial conclusion that medical management is superior to medical management with interventional therapy for all unruptured AVMs could be repudiated.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.