Acta Neurochirurgica

, Volume 131, Issue 3–4, pp 169–175 | Cite as

Prognostic value of the Spetzler's grading system in a series of cerebral AVMs treated by a combined management

  • R. Deruty
  • I. Pelissou-Guyotat
  • C. Mottolese
  • D. Amat
  • Y. Bascoulergue
Clinical Articles


The prognostic value of the Spetzler's grading system is studied in a series of 52 AVMs treated by a combined management, using one or several of the 3 available techniques: surgical resection, endovascular embolization, radiosurgery.

The symptoms at the time of treatment were haemorrhage 50%, seizures 31%, headache and deficit 19%. Three grade groups were considered: I and II (31%), III (33%), IV and V (36%). Overall, AVMs were managed as follows: resection alone 25%, embolization plus resection 23%, embolization alone 23%, radiosurgery with various combinations 29%. According to the grade groups, the most frequently used technique was resection alone for grade I–II AVMs (44%), radiosurgery for grade III AVMs (41%) and embolization alone for grade IV–V AVMs (42%).

The clinical outcome was evaluated in terms of deterioration due to treatment. The best results were obtained in grade I–II AVMs (81% with no deterioration) then in grade III AVMs (65%) and in grade IV–V (58%). However, when we consider the outcome in terms of favourable results (no or only minor deterioration) we obtained a similar outcome for grade I–II and grade III AVMs (94% each), and only 79% for grade IV–V malformations. The angiographic outcome showed a better eradication rate in grade III AVMs (88% complete eradication), than in grade I–II AVMs (75%) and in grade IV–V (47%).

Our conclusion is that the Spetzler's grading system in this series was well correlated with both the clinical and the angiographic outcome. However, we found no real difference between grade I–II and grade III AVMs. So, in terms of prognostic value, the grade I, II, and III AVMs could be considered together as low-grade malformations, with a better prognosis than the high-grade malformations (grade IV and V).


Arteriovenous malformations endovascular embolization radiosurgery grading of AVMs 


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  1. 1.
    Batjer HH, Devous MD, Seibert GB, Purdy PD, Bonte FJ, (1989) Intracranial AVMs. Relationship between clinical factors and surgical complications. Neurosurgery 24: 75–79PubMedGoogle Scholar
  2. 2.
    Drake CG (1978) Cerebral arteriovenous malformations. Consideration for and experience with surgical treatment in 166 cases. Clin Neurosurg 26: 145–208Google Scholar
  3. 3.
    Dobbelaere P, Jomin M, Clarisse E (1979) IntérÊt pronostique de l'étude du drainage veineux des anevrysmes artérioveineux cérébraux. Neurochirugie 25: 178–184Google Scholar
  4. 4.
    Hernesniemi J, Keranen T (1990) Microsurgical treatment of AVMs of the brain in a defined population. Surg Neurol 33: 384–390PubMedGoogle Scholar
  5. 5.
    Heros RC, Korosue K, Diebold PM (1990) Surgical excision of cerebral arteriovenous malformations. Late results. Neurosurgery 26: 570–578PubMedGoogle Scholar
  6. 6.
    Hollerhage HG, Dewenter KM, Dietz H (1992) Grading of supratentorial arteriovenous malformations on the basis of multivariate analysis of prognostic factors. Acta Neurochir (Wien) 117: 129–134Google Scholar
  7. 7.
    Jomin M, Lesoin F, Lozes G (1985) Prognosis for AVMs of the brain in adults based on 150 cases. Surg Neurol 23: 362–366PubMedGoogle Scholar
  8. 8.
    Laine E, Jomin M, Clarisse J, Combelles G (1981) Les malformations artérioveineuses profondes. Classifications topographiqes possibilités et résultats thérapeutiques. A propos de 46 observations. Neurochirurgie 27: 147–160PubMedGoogle Scholar
  9. 9.
    Luenssenhop AJ, Genarelli TA (1977) Anatomical grading of supratentorial AVMs for determining operability. Neurosurgery 1: 30–35PubMedGoogle Scholar
  10. 10.
    Mingrino S (1978) Supratentorial AVMs of the brain. In: Krayenbühl Het al (eds) Advances and technical standards in neurosurgery, Vol 5. Springer, Wien New York, pp93–126Google Scholar
  11. 11.
    Parkinson D, Bachers G (1980) Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. J Neurosurg 53: 285–299PubMedGoogle Scholar
  12. 12.
    Pasqualin A, Barone G, Gioffi F, Rosta L, Scienza R, Da Pian R (1991) The relevance of anatomic and hemodynamic factors to a classification of cerebral arteriovenous malformations. Neurosurgery 28: 370–379PubMedGoogle Scholar
  13. 13.
    Pelletieri L, Carlsson CA, Grevstens, Norlen G, Uhlemann C (1980) Surgical versus conservative treatment of intracranial arteriovenous malformations. A study in surgical decision making. Acta Neurochir (Wien) [Suppl] 29: 1–86Google Scholar
  14. 14.
    Pertuiset B, Ancri D, Kinuta Y, Haisa T, Bordi L, Lin C, Mahdi M, Arthuis F (1991) Classification of supratentorial arteriovenous malformations. A score system for evaluation of operability and surgical strategy. Based on an analysis of 66 cases. Acta Neurochir (Wien) 110: 6–16Google Scholar
  15. 15.
    Shi YQ, Chen XC (1986) A proposed scheme for grading intracranial AVMs. J Neurosurg 65: 484–489PubMedGoogle Scholar
  16. 16.
    Spetzler RF, Martin NA (1986) A proposed grading system for AVMs. J Neurosurg 65: 476–483PubMedGoogle Scholar
  17. 17.
    Spetzler RF, Zabramski JM (1989) Grading and staged resection of cerebral AVMs. Clin Neurosurg 36: 318–337Google Scholar
  18. 18.
    Steinmeier R, Shramm J, Muller HG, Fahlbusch R (1989) Evaluation of prognosis factors in cerebral AVMs. Neurosurgery 24: 193–201PubMedGoogle Scholar
  19. 19.
    Tamaki N, Ehara K, Lin Tin-Kai, Kuwamura K, Obora Y, Kanazawa Y, Yamadhita H, Matsumoto S (1991) Cerebral arteriovenous malformations: factors influencing the surgical difficulty and outcome. Neurosurgery 29: 856–863PubMedGoogle Scholar
  20. 20.
    Yasargil MG (1987) AVMs of the brain, history, embryology, pathological considerations, hemodynamics, diagnostic studies, microsurgical anatomy, Vol 3A. Thieme, Stuttgart, 408 ppGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • R. Deruty
    • 1
  • I. Pelissou-Guyotat
    • 1
  • C. Mottolese
    • 1
  • D. Amat
    • 1
  • Y. Bascoulergue
    • 1
  1. 1.Service de Neurochirurgie D. HÔpital Neurologique et Neuro-Chirurgical “Pierre Wertheimer”LyonFrance

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