A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score

Travis M Dumont; Peter Kan; Kenneth V Snyder; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy

doi:10.4103/2152-7806.148847

A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score

Surg Neurol Int. 2015 Jan 7:6:3. doi: 10.4103/2152-7806.148847. eCollection 2015.

Authors

Travis M Dumont¹, Peter Kan², Kenneth V Snyder³, L Nelson Hopkins⁴, Adnan H Siddiqui⁵, Elad I Levy⁶

Affiliations

¹ Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Division of Neurosurgery, Department of Surgery, The University of Arizona, Tucson, Arizona, USA.
² Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
³ Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA.
⁴ Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Jacobs Institute, Buffalo, New York, USA.
⁵ Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Jacobs Institute, Buffalo, New York, USA.
⁶ Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA.

Abstract

Background: The Spetzler-Martin arteriovenous malformation (AVM) grading system has proven to be useful in guiding treatment of cerebral AVMs with craniotomy. It is based on anatomical characteristics each of which makes surgical resection of an AVM more difficult, namely, deep venous drainage, eloquence of surrounding tissue, and large nidus size. A higher score correlates with more complications after treatment. Although this grading system has proven reliable over time, it does not reflect the major determinants of risk associated with endovascular treatment. The authors developed a grading system unique to endovascular treatment of cerebral AVMs.

Methods: The proposed grading system accounts for the principal AVM anatomical and physiological features that make endovascular embolization more difficult and, thus, the likelihood of complications greater. These include number of arterial pedicles, diameter of arterial pedicles, and eloquent location of AVM nidus. The proposed grading system was retrospectively applied to 50 patients undergoing endovascular AVM embolization, and its ability to predict complications was compared to the Spetzler-Martin grading system.

Results: Perioperative complications among the 50 patients included 4 major and 9 minor complications. The proposed grading system was predictive of complication risk, with an increasing rate of perioperative complications associated with an increasing AVM grade. An improved correlation of perioperative complication incidence was noted with the proposed system (P = 0.002), when compared with the Spetzler-Martin grading system (P = 0.33).

Conclusion: This grading system for the endovascular treatment of AVMs is simple, easily reproduced, and clinically valuable.

Keywords: Cerebral arteriovenous malformations; complications; endovascular glue embolization.

Abstract

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