Spetzler Martin Grade 5
Grade IV or V lesions are only treated in circumstances of progressive neurological deterioration from hemorrhage, vascular steal, or seizure as seen in a case, which had a high risk of rebleeding because of presentation at young age with hemorrhagic episode, large size of the nidus, deep venous drainage pattern and associated aneurysm within the AVM 1).
Volume-Staged CyberKnife Stereotactic Radiosurgery for Treatment of Drug Resistant Epilepsy for a Spetzler-Martin AVM grading system V Arteriovenous Malformation: A Case Report and Review of the Literature 2).
1)
Munakomi S, Bhattarai B, Cherian I. Case Report: Microsurgical excision of
grade 5 cerebral AVM. Version 2. F1000Res. 2015 Nov 2 [revised 2016 Jan
1];4:1197. eCollection 2015. PubMed PMID: 27853504; PubMed Central PMCID:
PMC5089143.
2)
Traylor JI, Johnson GS, Ashour R, Ghafoori P, Buchanan RJ. Volume-Staged
CyberKnife Stereotactic Radiosurgery for Treatment of Drug Resistant Epilepsy for
a Spetzler-Martin Grade V Arteriovenous Malformation: A Case Report and Review of
the Literature. World Neurosurg. 2019 Feb 21. pii: S1878-8750(19)30428-0. doi:
10.1016/j.wneu.2019.01.296. [Epub ahead of print] PubMed PMID: 30797935.