Spetzler-Martin Score
Spetzler-Martin score is used for the evaluation of surgical risk in patient suffering for AVMs.
Graded Feature |
Details |
Points |
| Size of AVM | Small (<3 cm) | 1 |
| Medium (3 cm - 6 cm) | 2 | |
| Large (>6 cm) | 3 | |
| Eloquence of adjacent brain | Non-eloquent | 0 |
| Eloquent | 1 | |
| Pattern of venous drainage | Superficial | 0 |
| Deep | 1 |
Grade |
% No Deficits |
% Minor Deficits |
% Major Deficits |
| 1 | 100 | 0 | 0 |
| 2 | 95 | 5 | 0 |
| 3 | 84 | 12 | 4 |
| 4 | 73 | 20 | 7 |
| 5 | 69 | 19 | 12 |
Spetzler-Ponce Classification
Spetzler-Ponce classification concerns treatment and prognosis of AVMs and it is based on the Spetzler-Martin score.
Class |
Spetzler-Martin Grade |
Management |
| A | 1-2 | Resection |
| B | 3 | Multimodal |
| C | 4-5 | No Treatment |
Note that in class C the treatment is admitted in presence of:
- Recurrent hemorrhage
- Progressive neurological deficits
- Steal-related symptoms
- AVM-related aneurysms
Yasargil's Classification
Yasargil classification is used for the evaluation of Vein of Galen malformations (VOGMS).
Type |
Description |
| 1 |
Pure cisternal fistula between pericallosal arteries, PCA and the vein of Galen |
| 2 | Fistoulous connections between the thalamoperforators (basilar and P1) and the vein of Galen |
| 3 | Mixed form (type 1 and type 2 features) |
| 4 |
Plexiform with one or more intrinsic niduses within the mesencephalon or thalamus with draining veins emptying into the vein of Galen: a. Pure Plexiform b. Plexiform combined with Type 1 (fistoulous cisterna nidus) |
Cognard Classification
Cognard classification assess venous drainage patterns of dural arterovenous fistulas and prognosis through angiographic methods.
Type |
Description |
| 1 | Anterograde drainage into sinus arteries, PCA and the vein of Galen |
| 2 |
a. Drainage into main sinus with reflux into a secondary sinus b. Drainage into main sinus with reflux into cortical veins c. Mixed type (2a and 2b) |
| 3 | Direct cortical venous drainage without ectasia |
| 4 | Direct cortical venous drainage with ectasia (>5 mm or 3x larger than diameter of draining vein) |
| 5 | Drainage into the spinal perimedullary veins |
References
A proposed grading system for arteriovenous malformations. Robert F.Spetzler, M.D et.al. Journal of Neurosurg 65:476-483, 1986
A 3-tier classi cation of cerebral arteriovenous malformations. RobeRt F. Spetzler, M.D., and FRanciSco a. ponce, M.D. Journal of Neurosurg 114:842–849, 2011
The prospective application of a grading system for arteriovenous malformations. Hamilton MG, Spetzler RF. Neurosurgery 34: 2-7, 1994
How safe is arteriovenous malformation surgery? A prospective, observational study for surgery as first line treatment for bran arteriovenous maformations. Davidson AS, Morgan MK. Neurosurgery 66: 498-505, 2010
Authors
|
Federico Nicolosi, MDNeurosurgeon |
Giorgio Saraceno, MSMedical Student |
