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SPETZLER-MARTIN GRADE III ARTERIOVENOUSMALFORMATIONS: SURGICAL RESULTS AND A
MODIFICATION OF THE GRADING SCALE
Michael T. Lawton, M.D.Department of Neurological Surgery, University of California, San Francisco, San Francisco,
California
Neurosurgery 2003, April, Volume 52, Number 4
A Supplementary Grading Scale for Selecting Patients with Brain
Arteriovenous Malformations for Surgery
Neurosurgery 2010, April, Volume 66, Number 4
Michael T. Lawton, M.D.Department of Neurological Surgery, University of California, San Francisco, San Francisco,
California
Methods - Neurosurgery 2003
174 AVM’s (174 patients) in 4.8 years
- 76 AVMs (45.2%) were Grade III
- Consecutive analysis
Why study Grade III?
Low-grade AVMs (Grades I and II) have low morbidity rates (0–5%) associated with their resection
Surgery
High-grade AVMs (Grades IV and V) have high morbidity rates (12-38%) associated with their resection
Monitorization
Why study Grade III?
Heterogenous: 4 different combination - Size
- Venous drainage - Eloquence
Combinations:
-S1V1E1 -S2V1E0 -S2V0E1 -S3V0E0
???????????
Size:
1 < = 3cm2 = 3- 6
cm3 > =6cm
Venous drainage:
0 = Superficial1 = Deep
Eloquenc
e:0 = No1 = Yes
Results
Improved Unchanged Worse Dead Lost to monitoring Total
S1V1E1 18 (51.4%) 15 (42.9%) 0 (0.0%) 1 (2.9%) 1 (2.9%) 35S2V1E0 4 (28.6%) 9 (64.3%) 1 (7.1%) 0 (0.0%) 0 (0.0%) 14
S2V0E1 9 (33.3%) 14 (51.9%) 2 (7.4%) 2 (7.4%) 0 (0.0%) 27S3V0E0 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0
Total 31 (40.8%) 38 (50.0%) 3 (3.9%) 3 (3.9%) 1 (1.3%) 76
Modification of the Spetzler-Martin grading scale
S1V1E1 = S&M III-can be safely treated with microsurgical resection
S2V0E1 = S&M III +have higher than expected surgical risks and might be better managed
conservatively(like many high-grade AVMs)
S2V1E0 = S&M III require carefully individualized treatment recommendations
and planning
S3V0E0 = S&M III*are either nonexistent or exceedingly rare, with a surgical risk that is
unclear
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