Affiliation:
1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
Abstract
Abstract
OBJECTIVE
To analyze surgical results for the highly variable Spetzler-Martin Grade III arteriovenous malformations (AVMs), to demonstrate that outcomes vary among the different types of Grade III lesions, and to introduce a simple modification of the grading scale that might improve its usefulness for these AVMs.
METHODS
In a consecutive series of 174 brain AVMs resected from 174 patients during a period of 4.8 years, 76 AVMs (45.2%) were Grade III. There were 35 small AVMs (S1V1E1) (46.1%), 14 medium/deep AVMs (S2V1E0) (18.4%), and 27 medium/eloquent AVMs (S2V0E1) (35.5%). No large Grade III AVM (S3V0E0) was treated.
RESULTS
Complete AVM resection was accomplished for 74 patients (surgical obliteration rate, 97.4%). Three patients (3.9%) experienced permanent, treatment-associated, neurological morbidity, and three patients died (surgical mortality rate, 3.9%). Good outcomes (Rankin scale scores of ≤2) were observed for 59 patients (78.7%). Surgical risks (new deficit or death), according to the Grade III type, were 2.9% for small AVMs (S1V1E1), 7.1% for medium/deep AVMs (S2V1E0), and 14.8% for medium/eloquent AVMs (S2V0E1).
CONCLUSION
Grade III AVMs are a heterogeneous group, with each type possessing different surgical risks, and the Spetzler-Martin grading scale should be modified accordingly. Grade III− AVMs (S1V1E1) have a surgical risk similar to that of low-grade AVMs and can be safely treated with microsurgical resection. Grade III+ AVMs (S2V0E1) have a surgical risk similar to that of high-grade AVMs and are best managed conservatively. Grade III AVMs (S2V1E0) have intermediate surgical risks and require judicious selection for surgery. Grade III* AVMs (S3V0E0) are either exceedingly rare, with a surgical risk that is unclear, or theoretical lesions with no clinical relevance.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Surgery
Reference18 articles.
1. Comprehensive management of arteriovenous malformations;de Oliveira;Neurol Res,1998
2. Cerebral arteriovenous malformations: Considerations for and experience with surgical treatment in 166 cases;Drake;Clin Neurosurg,1979
3. The prospective application of a grading system for arteriovenous malformations;Hamilton;Neurosurgery,1994
4. Intention-to-treat analysis of Spetzler-Martin Grade IV and V arteriovenous malformations: Natural history and treatment paradigm;Han;J Neurosurg,2003
5. The prospective application of the grading system for arteriovenous malformations;Heros;Neurosurgery,1994
Cited by
204 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献