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Case of the Month - September  2017

Patient with predominantly femoral right hemiparesis. Resonance and panangiography with findings consistent with a ruptured arteriovenous malformation. 

Patient underwent clipping and resection of the malformation through a frontoparietal craniotomy for an inter-hemispheric approach, with clipping and complete resection of the malformation. 

Spetzler-Martin Classification for Arveriovenous Malformations (AVMs)

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Grade

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  • AVM nest size

    • Small (<3cm) = 1

    • Medium (3-6cm) = 2

    • Large (> 6cm) = 3

  • Eloquent area of the brain?

    • Not eloquent  = 0

    • Eloquent = 1

  • Venous drainage

    • Only superficial  = 0

    • Deep = 1

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Eloquence of the brain
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Everything that controls the sensory or motor, language, visual cortex, thalamus, hypothalamus, brainstem, nuclei of the cerebellum, or the brain can be considered eloquent.  areas that are adjacent to them.

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References

 

1. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J. Neurosurg. 1986; 65 (4): 476-83.  doi: 10.3171 / jns.1986.65.4.0476  -  Pubmed citation

2. Iancu-Gontard D, Weill A, Guilbert F et-al. Inter- and intraobserver variability in the assessment of brain arteriovenous malformation angioarchitecture and endovascular treatment results. AJNR Am J Neuroradiol. 2007; 28 (3): 524-7.  AJNR Am J Neuroradiol (full text) 

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