A proposed grading system for arteriovenous malformations

Abstract

An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

WITHDRAWN: Predictors for complete obliteration of arteriovenous malformations following stereotactic radiosurgery

“…SM grade was initially proposed to determine the operative risks in patients undergoing surgery for AVM [29]. The factors considered in the grading system are size of nidus, the type of venous drainage (superficial vs deep) and the location of AVM in terms of eloquence.…”

Angiographic features help predict outcome after stereotactic radiosurgery for the treatment of pediatric arteriovenous malformations

“…SRS treatment parameters were also recorded at the time of SRS and included target volume, treated volume, prescription dose, prescription isodose contour, and number of treatment stages. Spetzler-Martin scores were calculated based on pre-SRS angiographic data [15]. Pollock scores were calculated based on initial SRS treatment [16].…”

Chorea Caused by Unruptured Arteriovenous Malformation: Case Report and Review of Literature

“…Arteriovenous malformations are classifi ed according to Spetzler-Martin's classifi cation in six grades. Th is classifi cation considers the size of the malformation, the proximity of the functional centers in the brain, so-called eloquent areas of the brain, and the type of venous drainage 36 . Also, this classifi cation is widely used for the choice of therapy and to predict the outcome of certain therapeutic procedures.…”

“…Also, this classifi cation is widely used for the choice of therapy and to predict the outcome of certain therapeutic procedures. Grade VI represents inoperable AVM 36 . Considering therapeutic outcomes of certain grades of AVM, in 2011 Spetzler and Ponce reclassifi ed Spetzler-Martin classifi cation into three groups: low surgical risk for grades I and II, intermediate surgical risk for grade III, and high risk for grades IV and V 37 .…”