[Prognostic value of grading systems in cerebral arteriovenous malformations]

The interrelationship between angiographic grading, clinical presentation and outcome in arteriovenous malformations was examined. For this purpose the grading scales as proposed by Luessenhop and Genarelli, Shi and Chen, and Spetzler and Martin were applied to 93 patients who had undergone surgery for cerebral arteriovenous malformations and whose angiographies were completely available for retrospective examination. Additionally the patients' clinical presentation on admission as well as their outcome were assigned to a 5 point scale. 44 of the 93 patients had a previous hemorrhage and 49 had become symptomatic for other reasons. There were 68 (73.2%) good and excellent results, 16 patients (17.2%) remained moderately and 7 (7.5%) severely disabled. There were 2 fatalities (2.1%). The correlation between the clinical and angiographical grading, respectively, and the outcome was assessed by determining Spearman's rank correlation coefficient (rho). The best correlation was found between the clinical grading on admission and the outcome (rho = 0.34). The angiographical classification scheme with the best correlation with the outcome was the one of Spetzler and Martin (rho = 0.22). The scales of Luessenhop and Genarelli and Shi and Chen correlated only weakly with the outcome (rho = 0.14 and rho = 0.12, respectively). The rounded off average of the grade of Spetzler and Martin and the clinical grade was the best predictor of outcome in our material (rho = 0.4).