Spetzler and Martin Grading for AVM



AVM Grading System

Spetzler-Martin grading system

  • stratify morbidity risk in patients following complete microsurgical resection of brain AVM to help inform treatment decision
  • AVM size (largest diameter of nidus)
    • < 3 cm = 1 point
    • 3-6 cm = 2 points
    • > 6 cm = 3 points
  • deep venous drainage = 1 point
    • deep veins include internal cerebral veins, basal veins, precentral cerebellar vein
    • all veins in posterior fossa are deep except for cerebellar hemispheric veins that drain into straight sinus transverse sinus
  • AVM adjacent to eloquent brain areas = 1 point
    • eloquent indicates identifiable neurological function and disabling neurological deficit if injured
    • includes sensorimotor, language, and visual cortices; hypothalamus and thalamus; internal capsule, brainstem, cerebellar peduncles, and deep cerebellar nuclei
  • grade = sum of scores (total score range 1-5 points)
  • major postsurgery deficits (0% mortality)
    • hemiparesis
    • long-term increase in aphasia
    • homonymous hemianopsia
    • severe deficit (including presumed normal perfusion pressure breakthrough) with major aphasia and hemiparesis

Postsurgery Outcomes Stratified by SM Grade:


AVM Validation

AVM Notes AVM Eloquent AVM morbidity  AVM factors AVM 08 AVM 01 AVM 02 AVM 03 AVM 04 AVM 05 AVM 06 AVM 07



Postsurgery Outcomes Stratified by SM Grade:




Spetzler, Robert F., and Neil A. Martin. “A Proposed Grading System For Arteriovenous Malformations”. Journal of Neurosurgery 65.4 (1986): 476-483. Web.

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