Microsurgical resection versus conservative management for unruptured brain arteriovenous malformations in the ARUBA era

This systematic review and meta-analysis evaluated post-ARUBA evidence comparing microsurgical resection against conservative management for patients with unruptured brain arteriovenous malformations (AVMs). Analyzing 14 studies from 2014 to 2026 across two analytic tracks, the researchers found that microsurgery achieved a 97.7% angiographic obliteration rate and was associated with lower rates of functional disability (9.6% vs. 15.1%) and stroke or death (3.7% vs. 10.1%) compared to the ARUBA trial's conservative management benchmark, alongside a 61% directional hazard reduction in comparative studies.

Ultimately, these findings suggest that microsurgical resection offers favorable outcomes below historical conservative benchmarks for low-grade, surgically amenable unruptured AVMs, though prospective randomized validation (such as the TOBAS trial) remains necessary to confirm these hypothesis-generating results.