A proposed scheme for grading intracranial arteriovenous malformations

Abstract

A four-grade classification scheme for intracranial arteriovenous malformations (AVM's) is proposed. Grading is based on the size of the AVM; its location and depth; its arterial supply; and its venous drainage. Each of these aspects is divided into four grades with respect to the difficulty it poses for surgical excision. A description of the grading system and its application is given. This grading scale has been correlated with the operative morbidity and mortality in 100 cases of excised intracranial AVM's. The results show that the higher the grade of AVM, the greater the risk of surgical morbidity and mortality. This grading scale is simple and easy to apply. It can guide neurosurgeons in selecting AVM patients suitable for operation, in determining the best type of operation to perform, and in predicting operative difficulties as well as postoperative results.

Grading and hemodynamic follow-up study of arteriovenous malformations with transcranial Doppler ultrasonography.

“…Therefore, one can conclude that PI is a more dependable parameter to evaluate the physiological success of the operation in early postoperative days. Since anatomic parameters remain the most important factors for determining the operability and surgical risks associated with AVMs, most widely accepted prognosticative grading systems such as Spetzler and Martin, 10 Shi and Chen, 25 and Luessenhop and Rosa 23 are based largely on morphologic criteria. Although, for practical purposes, maximum diameter was widely used to define the "size" of AVM, volume was proposed to be the best measure of AVM size.…”

A Grading System for Intracranial Arteriovenous Malformations Applicable to Endovascular Procedures

“…The aim of treating intracranial arteriovenous malformation is to remove the cumulative risk of bleeding with its inherent mortality and morbidity 1-4. Several papers have proposed a grading system for IC-AVM to predict the dif-ficulty of performing surgical resection [5][6][7] . Although these grading systems may be adequate enough to serve as a predictor, they all have a pure surgical view and have limited application when speaking about other therapeutic modalities such as endovascular embolization and stereotactic radiosurgery.…”

Intraventrikuläre arteriovenöse Malformationen

“…Diese Klassifikationen basieren zum einen auf der anatomischen Struktur der Angiome, ihrer zuführenden und abführenden Gefäße, zum andern auch auf Größe und Lokalisation der Gefäßmissbildung [18,26,27]. Die meisten Klassifikationen wurden von Neurochirurgen entwickelt, um eine Entscheidungshilfe bei der Frage der Operabilität und des zu erwartenden Operationsrisikos einer zerebralen AVM zu geben.…”