Editorial. Management of incidental cerebral AVMs in the post-ARUBA era

In this issue of the Journal of Neurosurgery, Yen and colleagues present a series of 31 patients with incidentally discovered arteriovenous malformations (AVMs) that were treated with Gamma Knife surgery (GKS) at the University of Virginia over a 20-year period. This article is important given the ongoing controversy regarding the management of unruptured AVMs, particularly in light of the recent results of the interim analysis of the ARUBA study (A Randomized Trial of Unruptured Brain Arteriovenous Malformations). In this series of 31 patients, the Spetzler-Martin grading at the time of initial GKS was Grade I in 4 patients, Grade II in 13 patients, Grade III in 12 patients, and Grade IV in 2 patients. Preradiosurgical embolization was performed in 5 patients. The overall mean nidus volume was 3.6 cm 3 and the median marginal dose was 20 Gy. The mean clinical, MRI, and angiographic follow-up was 78, 54, and 57.5 months, respectively. Four patients underwent repeat GKS at a mean of 6.8 years after the initial procedure.