The Role of Spetzler-Martin grading system in management of patients with intracranial arteriovenous malformation

Abstract

Introduction Brain arteriovenous malformation (AVM) is a pathology with an abnormal connection between arteries and veins, bypassing the capillary system. The current treatment of AVMs includes surgical excision, stereotactic radiosurgery, and endovascular techniques but the gold standard of treatment is surgical extirpation of AVM nidus in order to completely reduce the risk of haemorrhage [1]. Spetzler-Martin grading system (SMGS) has been widely accepted to estimate treatment risks and predict the outcome of patients with intracranial AVM and currently, the majority of neurosurgeons and interventional neuroradiologists worldwide choose treatment option according to this grading system [2-4]. Aim To compare management decision of brain AVM with recommended treatment option according to estimated surgical risk by SMGS. Objectives 1. To select theoretical treatment options by counting SMGS indices and to compare with chosen ones. 2. To compare complications rate within chosen treatment options. 3. To identify complications rate in mismatched treatment option cases.Methods From January 2005 to February 2014 90 patients with AVM were treated in Neurosurgery department, LSMU University Hospital. In the final retrospective analysis 68 adult patients (48 men and 20 women, mean age 43.19 years (SD 14.1)) who had surgery alone or combined with endovascular treatment, endovascular treatment or observation alone, and whose angiograms were available in database, were included. Demographic data, management decision and complications (ischemic, haemorrhagic, new onset of epileptic seizures, cerebral oedema) were analysed from patients case files while patients’ neuroimaging (CT and/or MRI) and cerebral angiograms were interpreted together with experienced invasive radiologist and neurosurgeon. Neuroimaging findings included localisation of the AVM and presence of haemorrhage. In cerebral angiograms localisation and size [...].