Spetzler-Martin

grading of brain arteriovenous malformations

Grades brain AVM surgical risk by size, eloquence of adjacent brain, and venous drainage.

vigenteNeurosurgical consensus1986MRI, Angiography

IGrade I, numeric score 1 IIGrade II, numeric score 2 IIIGrade III, numeric score 3 IVGrade IV, numeric score 4 VGrade V, numeric score 5 VIGrade VI, historical non-numeric designation for an essentially inoperable AVM

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Categorias

Reescritas a partir da fonte e citadas

1 de 6

Grade I, numeric score 1

Numeric total 1: a small nidus below 3 cm (S1), noneloquent adjacent brain (E0), and superficial venous drainage only (V0); the only valid component profile is S1E0V0.

CondutaUse grade I as one estimate of risk from open microsurgical resection and retain the S/E/V profile. The grade does not by itself choose observation, surgery, embolization or radiosurgery.

RiscoLowest numeric microsurgical-risk grade in the scale. It predicts operative morbidity and mortality comparatively, not the untreated hemorrhage risk.

verificadoA proposed grading system for arteriovenous malformationsSpetzler and Martin 1986, PMID 3760956 abstract: grade I is small, superficial and noneloquent; CNS Clinical Neurosurgery 2011, Table 1: size, eloquence and drainage points.

2 de 6

Grade II, numeric score 2

Numeric total 2. Valid S/E/V profiles are S1E1V0, S1E0V1 or S2E0V0, where S1 is below 3 cm and S2 is 3-6 cm inclusive.

CondutaUse grade II as one estimate of risk from open microsurgical resection and report the actual S/E/V profile. The grade does not by itself choose a treatment modality.

RiscoRelatively low numeric microsurgical-risk grade, but different size, eloquence and drainage combinations can produce the same total and remain clinically relevant.

verificadoA proposed grading system for arteriovenous malformationsCNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: S=1-3, E=0-1 and V=0-1; arithmetic profiles summing to 2. NCBI Bookshelf NBK531479, Spetzler-Martin section.

III

3 de 6

Grade III, numeric score 3

Numeric total 3. Valid profiles are S1E1V1, S2E1V0, S2E0V1 or S3E0V0; grade III is therefore anatomically heterogeneous and the component profile must accompany the total.

CondutaUse grade III as one estimate of open-microsurgical risk and preserve the S/E/V subtype for multidisciplinary planning. The numeric total alone does not select embolization or any other treatment.

RiscoIntermediate numeric microsurgical-risk grade whose risk is not uniform across its component profiles; it is not a measure of spontaneous hemorrhage risk.

verificadoA proposed grading system for arteriovenous malformationsCNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; the four listed profiles are the complete arithmetic combinations summing to 3.

4 de 6

Grade IV, numeric score 4

Numeric total 4. Valid profiles are S2E1V1, S3E1V0 or S3E0V1, combining a medium or large nidus with eloquence and/or deep venous drainage.

CondutaTreat grade IV as a high open-microsurgical-risk descriptor and retain the S/E/V profile. Final management requires individualized neurovascular review and is not dictated by the grade alone.

RiscoHigh numeric risk for morbidity and mortality from open microsurgical resection; the scale does not directly estimate embolization, radiosurgery or natural-history risk.

verificadoA proposed grading system for arteriovenous malformationsCNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; NCBI Bookshelf NBK531479 states that perioperative risk increases with grade and does not necessarily transfer to other modalities.

5 de 6

Grade V, numeric score 5

Numeric total 5, the maximum additive score: large nidus above 6 cm (S3), eloquent adjacent brain (E1), and any deep venous drainage (V1), profile S3E1V1.

CondutaTreat grade V as the highest numeric open-microsurgical-risk descriptor and retain the S/E/V profile. Final management requires individualized neurovascular review and is not dictated by the grade alone.

RiscoHighest numeric microsurgical-risk grade. The original article characterizes grade V as large, deep and neurologically critical, without making it a patient-specific probability.

verificadoA proposed grading system for arteriovenous malformationsSpetzler and Martin 1986, PMID 3760956 abstract: grade V lesions are large, deep and in neurologically critical areas; CNS Clinical Neurosurgery 2011, Table 1: maximum profile S3E1V1.

6 de 6

Grade VI, historical non-numeric designation for an essentially inoperable AVM

Historical special designation from the original publication for an AVM judged essentially inoperable. Grade VI is an expert designation outside the 1-5 additive S/E/V calculation and cannot be generated by summing points.

CondutaDo not calculate grade VI from imaging points or treat the label as an automatic no-treatment command. If the historical designation is used, state that it is non-numeric and requires specialist neurovascular judgment.

RiscoThe original designation represents operative concern beyond numeric grade V, but it supplies no separate quantitative risk estimate and does not measure natural-history hemorrhage risk.

verificadoA proposed grading system for arteriovenous malformationsSpetzler and Martin 1986, PMID 3760956 abstract: all AVMs were described in six grades and grade VI as essentially inoperable; NCBI Bookshelf NBK531479 distinguishes numeric grades I-V from the special grade VI designation.

Lógica de decisão estruturada

Return the numeric grade together with S/E/V components. Grade VI is a historical expert designation outside the arithmetic sum; the scale is a microsurgical-risk tool, not an automatic treatment rule.

{
  "applicability": {
    "use_for": "Preoperative anatomic grading of a brain arteriovenous malformation to estimate neurologic morbidity and mortality from open microsurgical resection.",
    "required_inputs": [
      "maximum_nidus_diameter_cm",
      "eloquence_of_adjacent_brain",
      "venous_drainage_pattern"
    ],
    "imaging_basis": [
      "cross_sectional_neuroimaging",
      "catheter_angiography"
    ]
  },
  "feature_groups": [
    {
      "id": "S_nidus_size",
      "measurement": "maximum_nidus_diameter_cm",
      "options": [
        {
          "finding": "<3_cm",
          "points": 1
        },
        {
          "finding": "3_to_6_cm_inclusive",
          "points": 2
        },
        {
          "finding": ">6_cm",
          "points": 3
        }
      ]
    },
    {
      "id": "E_eloquence",
      "definition": "Adjacent brain whose injury would produce a disabling neurologic deficit.",
      "eloquent_regions": [
        "sensorimotor_cortex",
        "language_cortex",
        "visual_cortex",
        "hypothalamus",
        "thalamus",
        "internal_capsule",
        "brainstem",
        "cerebellar_peduncles",
        "deep_cerebellar_nuclei"
      ],
      "options": [
        {
          "finding": "noneloquent",
          "points": 0
        },
        {
          "finding": "eloquent",
          "points": 1
        }
      ]
    },
    {
      "id": "V_venous_drainage",
      "deep_rule": "Assign one point when any drainage enters the deep cerebral venous system. In the posterior fossa, cerebellar hemispheric veins draining directly to the straight or transverse sinus are treated as superficial.",
      "options": [
        {
          "finding": "superficial_only",
          "points": 0
        },
        {
          "finding": "any_deep_drainage",
          "points": 1
        }
      ]
    }
  ],
  "calculation": "Add S + E + V. The numeric sum ranges from 1 to 5 and equals Spetzler-Martin grade I-V.",
  "score_map": [
    {
      "total": 1,
      "outcome_code": "I",
      "valid_profiles": [
        "S1E0V0"
      ]
    },
    {
      "total": 2,
      "outcome_code": "II",
      "valid_profiles": [
        "S1E1V0",
        "S1E0V1",
        "S2E0V0"
      ]
    },
    {
      "total": 3,
      "outcome_code": "III",
      "valid_profiles": [
        "S1E1V1",
        "S2E1V0",
        "S2E0V1",
        "S3E0V0"
      ]
    },
    {
      "total": 4,
      "outcome_code": "IV",
      "valid_profiles": [
        "S2E1V1",
        "S3E1V0",
        "S3E0V1"
      ]
    },
    {
      "total": 5,
      "outcome_code": "V",
      "valid_profiles": [
        "S3E1V1"
      ]
    },
    {
      "assignment": "historical_non_numeric_expert_designation",
      "outcome_code": "VI",
      "interpretation": "The original publication reserved grade VI for an AVM judged essentially inoperable; it is not produced by the additive score."
    }
  ],
  "reporting_requirements": [
    "report_grade",
    "report_S_E_V_component_profile",
    "state_maximum_nidus_diameter",
    "state_eloquent_structure",
    "state_presence_of_any_deep_drainage"
  ],
  "limitations": [
    "The grade predicts risk of open microsurgical resection, not the untreated hemorrhage risk.",
    "It does not directly predict risks of embolization or stereotactic radiosurgery and does not select a treatment by itself.",
    "Grade III contains materially different anatomic profiles; retain the S/E/V components rather than reporting only the total."
  ],
  "source_locator": "Spetzler and Martin 1986, PMID 3760956, abstract and original grading table as reproduced with permission in the Congress of Neurological Surgeons Clinical Neurosurgery chapter, Table 1; NCBI Bookshelf NBK531479, Spetzler-Martin section, for operational definitions."
}

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