Cerebral Arteriovenous Malformation Grading

• Encephaloduroarteriosynangiosis for the Treatment of Cerebral Arteriovenous Malformations in the Pediatric Population
• Pediatric cerebral arteriovenous malformation diagnosed 11 years after neonatal thalamic hemorrhage: illustrative case
• Improbable discovery of an incidental high-grade AVM: illustrative case
• Repeated stereotactic radiosurgery for residual intracranial dural arteriovenous fistulas
• Robotic radiosurgery for the treatment of pediatric arteriovenous malformations
• Complications after Gamma Knife Radiosurgery for Brain AVMs: Predictive factors for symptomatic radionecrosis
• Impact of embolization on stereotactic radiosurgery outcomes for intracranial arteriovenous malformations Spetzler-Martin grades III-V: a systematic review and meta-analysis
• Lack of correlation between cerebral arteriovenous malformation angioarchitectural and hemodynamic characteristics and systemic inflammation

Screening of 865 papers revealed thirteen grading systems ^{1) 2) 3) 4) 5) 6)}. for cerebral arteriovenous malformation microsurgical risk stratification. Among them, two systems were specifically developed for ruptured cerebral arteriovenous malformation and one specifically for posterior fossa arteriovenous malformation. With one system being fundamentally different for supratentorial bAVM, the remaining nine systems used the same parameters: “size,” “eloquence,” “venous drainage,” “arterial feeders,” “age,” “nidus compactness,” and “hemorrhagic presentation”. This study provides a comprehensive overview of all available bAVM grading systems relevant for surgical risk stratification. Furthermore, in the absence of a universal system appropriate to score all bAVMs, a workflow for selection of the best applicable scoring system in accordance with bAVM subgroups is presented ⁷⁾.

The first major Cerebral Arteriovenous Malformation Grading scheme developed by Luessenhop and Gennarelli in 1977 ⁸⁾ formulated a grade from I to IV based on the number of feeding arteries for which it is standardized nomenclature ⁹⁾

Luessenhop and Rosa ¹⁰⁾ simplified this grading scheme in 1984 by considering only the angiographic size of the AVM, which was believed to be easier than counting arterial feeders. The new grades were assigned based on nidus diameter: grade I, less than 2 cm; grade II, 2 to 4 cm; grade III, 4 to 6 cm; and grade IV, greater than 6 cm. The original classification scheme excluded AVMs in the cerebellum, brain stem, and region of the vein of Galen malformations, whereas the new scheme included cerebellar arteriovenous malformations ¹¹⁾

The Spetzler-Martin AVM grading system is the most widely used grading system for AVMs.

see also Supplementary Spetzler-Martin AVM grading scale.

see Spetzler Ponce classification.