Notes
Original Spetzler-Martin grade
- Points are assigned in the following manner:
- Size of nidus
- <3 cm: 1
- 3-6 cm: 2
- >6 cm: 3
- + 1 point if the adjacent brain is eloquent
- Eloquent areas are:
- sensory, motor, visual, or language cortical areas
- internal capsule
- thalamus and hypothalamus
- brainstem
- cerebellar peduncles
- deep cerebellar nuclei
- Eloquent areas are:
- +1 point if there is deep venous drainage
- any drainage to the deep cerebral veins and most cerebellar hemispheric veins (unless they drain directly into the straight or transverse sinus)
- Size of nidus
- In the original system a grade I-V can be assigned based on the points
- A separate “grade VI” was reserved for diffuse nidus arteriovenous malformations, which were considered largely inoperable at the time when the original system was published
- This entity is now referred as cerebral proliferative angiopathy
Supplemented Spetzler-Martin (SM-Supp) grade
- Th supplemented system was proposed to facilitate selection of candidates with good surgical and neurologic outcome
- Further points are assigned as follows:
- Age at resection
- <20: 1
- 20-40: 2
- >40: 3
- Bleeding prior to resection
- ruptured: 0
- unruptured: 1
- +1 point if the nidus is diffuse
- Age at resection
- A supplemented Spetzler-Martin grade ≤6 represents lower sugical risk and potentially better long term neurologic outcome
Further reading
Last updated: 2022-01-17