Spetzler-Martin Grade III arteriovenous malformations: surgical results and a modification of the grading scale.

摘要

OBJECTIVE: To analyze surgical results for the highly variable Spetzler-Martin Grade III arteriovenous malformations (AVMs), to demonstrate that outcomes vary among the different types of Grade III lesions, and to introduce a simple modification of the grading scale that might improve its usefulness for these AVMs. METHODS: In a consecutive series of 174 brain AVMs resected from 174 patients during a period of 4.8 years, 76 AVMs (45.2%) were Grade III. There were 35 small AVMs (S1V1E1) (46.1%), 14 medium/deep AVMs (S2V1E0) (18.4%), and 27 medium/eloquent AVMs (S2V0E1) (35.5%). No large Grade III AVM (S3V0E0) was treated. RESULTS: Complete AVM resection was accomplished for 74 patients (surgical obliteration rate, 97.4%). Three patients (3.9%) experienced permanent, treatment-associated, neurological morbidity, and three patients died (surgical mortality rate, 3.9%). Good outcomes (Rankin scale scores of