ORIGINAL PAPER
Cerebral arteriovenous malformations – usability of Spetzler-Martin and Spetzler-Ponce scales in qualification to endovascular embolisation and neurosurgical procedure
 
More details
Hide details
 
Publication date: 2018-05-29
 
 
Pol J Radiol, 2018; 83: 243-247
 
KEYWORDS
ABSTRACT
Purpose:
Arteriovenous malformations (AVMs) are connected with cerebral haemorrhage, seizures, increased intracranial pressure, headaches, mass effect, and ischaemia symptoms. Selection of the best treatment method or even deciding if intervention is required can be difficult.

Material and methods:
The study included 50 patients who were diagnosed with cerebral AVMs and treated in our Centre between 2008 and 2014. A total of 111 procedures were performed, including 94 endovascular embolisations and 17 neurosurgical procedures. Medical records and imaging data were reviewed for all patients. All AVMs were measured and assessed, allowing classification in Spetzler-Martin and Spetzler-Ponce scales.

Results:
Complete or partial treatment was observed in 88.24% of neurosurgical procedures and in 84.00% of embolisations. Early complication rate was 21.28% for embolisation and 17.65% for neurosurgical procedures, while Glasgow Outcome Scale was 4.89 (σ = 0.38) and 5.0 (σ = 0.00), respectively. According to the Spetzler-Martin scale, cerebral haemorrhages occurred more frequently in grade 1, but no statistical significance was observed. In Spetzler-Ponce class B lower grades in Glasgow Coma Scale (GCS) were noticed (p = 0.02). Lower GCS scores were also correlated with deep location of AVM and with eloquence of adjacent brain. Patients with Spetzler-Martin grade 1 were more frequently qualified for neurosurgical procedures than other patients.

Conclusions:
Treating AVMs requires coordination of a multidisciplinary team. Both endovascular embolisation and neurosurgical procedure should be considered as a part of multimodal, frequently multistage treatment. Spetzler-Martin and Spetzler-Ponce scales have an influence on haemorrhage frequency and patients’ clinical condition and should be taken into consideration in selecting the treatment method.

 
REFERENCES (25)
1.
Greenberg MS. Handbook of Neurosurgery. Thieme, New York 2006; 835-839.
 
2.
Ajiboye N, Chalouhi N, Starke MR, et al. Cerebral arteriovenous malformations: evaluation and management. Sci World J 2014; 649036.
 
3.
Abecassis IJ, Xu DS, Batjer HH, Bendok BR. Natural history of brain arteriovenous malformations: a systematic review. Neurosurg Focus 2014; 37: E7.
 
4.
Gross BA, Scott RM, Smith ER. Management of brain arteriovenous malformations. Lancet 2014; 383: 1635.
 
5.
Ogilvy CS, Stieg PE, Awad I, et al. Recommendations for the Management of Intracranial Arteriovenous Malformations. A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Stroke Association. Stroke 2001; 32: 1458-1471.
 
6.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-84.
 
7.
Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65: 476-483.
 
8.
Spetzler RF, Ponce FA. A 3-tier classification of cerebral arteriovenous malformations. J Neurosurg 2011; 114: 842-849.
 
9.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1: 480-484.
 
10.
Hartmann A, Mast H, Mohr JP, et al. Determinants of Staged Endo­vascular and Surgical Treatment Outcome of Brain Arteriovenous Malformations. Stroke 2005; 36: 2431-2435.
 
11.
Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet 2014; 383: 614-621.
 
12.
Al-Shahi R, Stapf C. The prognosis and treatment of arteriovenous malformations of the brain. Pract Neurol 2005; 5: 194-205.
 
13.
Potts MB, Lau D, Abla AA, et al. Current surgical results with low-grade brain arteriovenous malformations. J Neurosurg 2015; 122: 912-920.
 
14.
Stapf C, Mohr JP, Choi JH, et al. Invasive treatment of unruptured brain arteriovenous malformations is experimental therapy. Curr Opin Neurol 2006; 19: 63-68.
 
15.
Ellis JA, Lavine SD. Role of Embolization for Cerebral Arteriovenous Malformations. Methodist Debakey Cardiovasc J 2014; 10: 234-239.
 
16.
Pierot L, Cognard C, Herbreteau D, et al. Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO). Eur Radiol 2013; 23: 2838-2845.
 
17.
Davis SM, Donnan GA. Unruptured brain arteriovenous malformations: another asymptomatic conundrum. Stroke 2007; 38: 3312.
 
18.
Thapa A, Chandra S, Sinha S, et al. Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario. Neurol India 2009; 57: 749-755.
 
19.
Morgan MK, Zurin AA, Harrington T, Little N. Changing role for preoperative embolisation in the management of arteriovenous malformations of the brain. J Clin Neurosci 2000; 7: 527-530.
 
20.
Davies JM, Yanamadala V, Lawton MT. Comparative effectiveness of treatments for cerebral arteriovenous malformations: trends in nationwide outcomes from 2000 to 2009. Neurosurg Focus 2012; 33: E11.
 
21.
Hamilton MG, Spetzler RF. The prospective application of a grading system for arteriovenous malformations. Neurosurgery 1994; 34: 2-6.
 
22.
Hofmeister C, Stapf C, Hartmann A, et al. Demographic, morphological and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke 2000; 31: 1307-1310.
 
23.
Elhammady MS, Heros RC. Surgical management of unruptured cerebral arteriovenous malformations. J Neurosurg 2014; 121: 875-877.
 
24.
Feliciano CE, de Leon-Berra R, Hernandez-Gaitan MS, Rodriguez-Mercado R. A proposal for a new arteriovenous malformation grading scale for neuroendovascular procedures and literature review. P R Health Sci J 2010; 29: 117-120.
 
25.
Dumont T, Kan P, Snyder KV, et al. A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score. Surg Neurol Int 2015; 6: 3.
 
Journals System - logo
Scroll to top