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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery
Michael T Lawton1, Helen Kim, Charles E McCulloch
1Department of Neurological Surgery, and Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California, USA. lawtonm@neurosurg.ucsf.edu
Neurosurgery
|March 2, 2010
Summary
A new grading system for brain arteriovenous malformations (AVMs) improves prediction of surgical outcomes. This supplementary AVM grade offers better accuracy than the Spetzler-Martin system for patient selection.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Patient age, hemorrhagic presentation, nidal diffuseness, and deep perforating artery supply are key factors in selecting patients with brain arteriovenous malformations (AVMs) for surgery.
- The Spetzler-Martin grading system is widely used but may not capture all relevant prognostic indicators.
Purpose of the Study:
- To develop and validate a supplementary grading system for brain AVMs.
- To improve prediction of neurologic outcomes and refine patient selection for AVM surgery.
- To combine factors beyond the Spetzler-Martin grading system into a simple, supplementary tool.
Main Methods:
- Analysis of a consecutive, single-surgeon series of 300 patients with AVMs treated microsurgically.
- Evaluation of changes in modified Rankin Scale scores from preoperative to final postoperative status.
- Construction of multivariable logistic models, including the Spetzler-Martin and a supplementary model, to assess predictor variables.
Main Results:
- The full multivariable model showed the highest predictive accuracy (ROC area, 0.78).
- The supplementary grading system demonstrated significantly better predictive accuracy (ROC area, 0.73) than the Spetzler-Martin grade (ROC area, 0.65; P = .042).
- The supplementary model's accuracy was also higher than the Spetzler-Martin model alone.
Conclusions:
- A new supplementary AVM grading system enhances prediction of neurologic outcomes after surgery.
- This system supplements, rather than replaces, the Spetzler-Martin grading system.
- The supplementary grading system is accurate, stratifies risk evenly, and is easily applicable at the bedside for improved preoperative decision-making.
