Testing the radiosurgery-based arteriovenous malformation score and the modified Spetzler—Martin grading system to predict radiosurgical outcome

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Object. The aim of this study was to validate the radiosurgery-based arteriovenous malformation (AVM) score and the modified Spetzler—Martin grading system to predict radiosurgical outcome.

Methods. One hundred thirty-six patients with brain AVMs were randomly selected. These patients had undergone a linear accelerator radiosurgical procedure at a single center between 1989 and 2000. Patients were divided into four groups according to an AVM score, which was calculated from the lesion volume, lesion location, and patient age (Group 1, AVM score < 1; Group 2, AVM score 1–1.49; Group 3, AVM score 1.5–2; and Group 4, AVM score > 2). Patients with a Spetzler—Martin Grade III AVM were divided into Grades IIIA (lesion > 3 cm) and IIIB (lesion < 3 cm). Sixty-two female (45.6%) and 74 male (54.4%) patients with a median age of 37.5 years (mean 37.5 years, range 5–77 years) were followed up for a median of 40 months. The median tumor margin dose was 15 Gy (mean 17.23 Gy, range 15–25 Gy). The proportions of excellent outcomes according to the AVM score were as follows: 91.7% for Group 1, 74.1% for Group 2, 60% for Group 3, and 33.3% for Group 4 (chi-square test, degrees of freedom (df) = 3, p < 0.001). Based on the modified Spetzler—Martin system, Grade I lesions had 88.9% excellent results; Grade II, 69.6%; Grade IIIB, 61.5%; and Grades IIIA and IV, 44.8% (chi-square test, df = 3, p = 0.047).

Conclusions. The radiosurgery-based AVM score can be used accurately to predict excellent results following a single radiosurgical treatment for AVM. The modified Spetzler—Martin system can also predict radiosurgical results for AVMs, thus making it possible to use this system while deciding between surgery and radiosurgery.

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Contributor Notes

Address reprint requests to: Michael L. Schwartz, M.D., F.R.C.S.(C), Division of Neurosurgery, Suite A129, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. email: m.schwartz@utoronto.ca.
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References
  • 1.

    Barker FG IIButler WELyons SCascio EOgilvy CSLoeffler JSet al: Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg 99:2542632003Barker FG II Butler WE Lyons S Cascio E Ogilvy CS Loeffler JS et al: Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg 99:254–263 2003

    • Search Google Scholar
    • Export Citation
  • 2.

    Coffey RJNichols DAShaw EG: Stereotactic radiosurgical treatment of cerebral arteriovenous malformations. Gamma Unit Radiosurgery Study Group. Mayo Clin Proc 70:2142221995Coffey RJ Nichols DA Shaw EG: Stereotactic radiosurgical treatment of cerebral arteriovenous malformations. Gamma Unit Radiosurgery Study Group. Mayo Clin Proc 70:214–222 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    de Oliveira ETedeschi HRaso J: Comprehensive management of arteriovenous malformations. Neurol Res 20:6736831998de Oliveira E Tedeschi H Raso J: Comprehensive management of arteriovenous malformations. Neurol Res 20:673–683 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Deruty RPelissou-Guyotat IMorel CBascoulergue YTurjman F: Reflections on the management of cerebral arteriovenous malformations. Surg Neurol 50:2452561998Deruty R Pelissou-Guyotat I Morel C Bascoulergue Y Turjman F: Reflections on the management of cerebral arteriovenous malformations. Surg Neurol 50:245–256 1998

    • Search Google Scholar
    • Export Citation
  • 5.

    Ellis TLFriedman WABova FJKubilis PSBuatti JM: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:1041101998Ellis TL Friedman WA Bova FJ Kubilis PS Buatti JM: Analysis of treatment failure after radiosurgery for arteriovenous malformations. J Neurosurg 89:104–110 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    Fisher WS III: Therapy of AVMs: a decision analysis. Clin Neurosurg 42:2943121995Fisher WS III: Therapy of AVMs: a decision analysis. Clin Neurosurg 42:294–312 1995

    • Search Google Scholar
    • Export Citation
  • 7.

    Foote KDFriedman WAEllis TLBova FJBuatti JMMeeks SL: Salvage retreatment after failure of radiosurgery in patients with arteriovenous malformations. J Neurosurg 98:3373412003Foote KD Friedman WA Ellis TL Bova FJ Buatti JM Meeks SL: Salvage retreatment after failure of radiosurgery in patients with arteriovenous malformations. J Neurosurg 98:337–341 2003

    • Search Google Scholar
    • Export Citation
  • 8.

    Friedman WABova FJBollampally SBradshaw P: Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 52:2963082003Friedman WA Bova FJ Bollampally S Bradshaw P: Analysis of factors predictive of success or complications in arteriovenous malformation radiosurgery. Neurosurgery 52:296–308 2003

    • Search Google Scholar
    • Export Citation
  • 9.

    Gillies BAO'Brien PFMcVittie RMcParland CEaston H: Engineering modifications for dynamic stereotactically assisted radiotherapy. Med Phys 20:149114951993Gillies BA O'Brien PF McVittie R McParland C Easton H: Engineering modifications for dynamic stereotactically assisted radiotherapy. Med Phys 20:1491–1495 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Hamilton MGSpetzler RF: The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:271994Hamilton MG Spetzler RF: The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:2–7 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    Hartmann AStapf CHofmeister CMohr JPSciacca RRStein BMet al: Determinants of neurological outcome after surgery for brain arteriovenous malformation. Stroke 31:236123642000Hartmann A Stapf C Hofmeister C Mohr JP Sciacca RR Stein BM et al: Determinants of neurological outcome after surgery for brain arteriovenous malformation. Stroke 31:2361–2364 2000

    • Search Google Scholar
    • Export Citation
  • 12.

    Heffez DSOsterdock RJAlderete LGrutsch J: The effect of incomplete patient follow-up on the reported results of AVM radiosurgery. Surg Neurol 49:3733841998Heffez DS Osterdock RJ Alderete L Grutsch J: The effect of incomplete patient follow-up on the reported results of AVM radiosurgery. Surg Neurol 49:373–384 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Heros RCKorosue KDiebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:5705781990Heros RC Korosue K Diebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578 1990

    • Search Google Scholar
    • Export Citation
  • 14.

    Hollerhage HGZumkeller MDewenter KM: Zum prognostischen Wert von Graduierungssystem en bei zerebralen arteriovenous Missbildungen. Neurochirurgia (Stuttg) 33:59641990Hollerhage HG Zumkeller M Dewenter KM: Zum prognostischen Wert von Graduierungssystem en bei zerebralen arteriovenous Missbildungen. Neurochirurgia (Stuttg) 33:59–64 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    Karlsson BKihlstrom LLindquist CSteiner L: Gamma knife surgery for previously irradiated arteriovenous malformations. Neurosurgery 42:161998Karlsson B Kihlstrom L Lindquist C Steiner L: Gamma knife surgery for previously irradiated arteriovenous malformations. Neurosurgery 42:1–6 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Karlsson BLindquist CSteiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:4254311997Karlsson B Lindquist C Steiner L: Prediction of obliteration after gamma knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431 1997

    • Search Google Scholar
    • Export Citation
  • 17.

    Lawton MT: Spetzler—Martin Grade III arteriovenous malformations: surgical results and a modification of the grading scale. Neurosurgery 52:7407492003Lawton MT: Spetzler—Martin Grade III arteriovenous malformations: surgical results and a modification of the grading scale. Neurosurgery 52:740–749 2003

    • Search Google Scholar
    • Export Citation
  • 18.

    Maesawa SFlickinger JCKondziolka DLunsford LD: Repeated radiosurgery for incompletely obliterated arteriovenous malformations. J Neurosurg 92:9619702000Maesawa S Flickinger JC Kondziolka D Lunsford LD: Repeated radiosurgery for incompletely obliterated arteriovenous malformations. J Neurosurg 92:961–970 2000

    • Search Google Scholar
    • Export Citation
  • 19.

    Meder JFOppenheim CBlustajn JNataf FMerienne LLefkoupolos Det al: Cerebral arteriovenous malformations: the value of radiologic parameters in predicting response to radiosurgery. AJNR Am J Neuroradiol 18:147314831997Meder JF Oppenheim C Blustajn J Nataf F Merienne L Lefkoupolos D et al: Cerebral arteriovenous malformations: the value of radiologic parameters in predicting response to radiosurgery. AJNR Am J Neuroradiol 18:1473–1483 1997

    • Search Google Scholar
    • Export Citation
  • 20.

    Morgan MKSekhon LHFinfer SGrinnell V: Delayed neurological deterioration following resection of arteriovenous malformations of the brain. J Neurosurg 90:6957011999Morgan MK Sekhon LH Finfer S Grinnell V: Delayed neurological deterioration following resection of arteriovenous malformations of the brain. J Neurosurg 90:695–701 1999

    • Search Google Scholar
    • Export Citation
  • 21.

    Nozaki KHashimoto NMiyamoto SKikuchi H: Resectability of Spetzler—Martin grade IV and V cerebral arteriovenous malformations. J Clin Neurosci 7 (Suppl 1):78812000Nozaki K Hashimoto N Miyamoto S Kikuchi H: Resectability of Spetzler—Martin grade IV and V cerebral arteriovenous malformations. J Clin Neurosci 7 (Suppl 1):78–81 2000

    • Search Google Scholar
    • Export Citation
  • 22.

    O'Brien PFGillies BASchwartz MYoung CDavey P: Radiosurgery with unflattened 6-mV photon beams. Med Phys 18:5195211991O'Brien PF Gillies BA Schwartz M Young C Davey P: Radiosurgery with unflattened 6-mV photon beams. Med Phys 18:519–521 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    Ogilvy CSStieg PEAwad IBrown RD JrKondziolka DRosenwasser Ret al: AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke 32:145814712001Ogilvy CS Stieg PE Awad I Brown RD Jr Kondziolka D Rosenwasser R et al: AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council American Stroke Association. Stroke 32:1458–1471 2001

    • Search Google Scholar
    • Export Citation
  • 24.

    Olivier ABertrand G: Stereotaxic device for percutaneous twist-drill insertion of depth electrodes and for brain biopsy. Technical note. J Neurosurg 56:3073081982Olivier A Bertrand G: Stereotaxic device for percutaneous twist-drill insertion of depth electrodes and for brain biopsy. Technical note. J Neurosurg 56:307–308 1982

    • Search Google Scholar
    • Export Citation
  • 25.

    Pik JHMorgan MK: Microsurgery for small arteriovenous malformations of the brain: results in 110 consecutive patients. Neurosurgery 47:571575; discussion 575–5772000Pik JH Morgan MK: Microsurgery for small arteriovenous malformations of the brain: results in 110 consecutive patients. Neurosurgery 47:571–575; discussion 575–577 2000

    • Search Google Scholar
    • Export Citation
  • 26.

    Podgorsak EBOlivier APla MLefebvre PYHazel J: Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 14:1151261988Podgorsak EB Olivier A Pla M Lefebvre PY Hazel J: Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 14:115–126 1988

    • Search Google Scholar
    • Export Citation
  • 27.

    Pollock BEFlickinger JC: A proposed radiosurgery-based grading system for arteriovenous malformations. J Neurosurg 96:79852002Pollock BE Flickinger JC: A proposed radiosurgery-based grading system for arteriovenous malformations. J Neurosurg 96:79–85 2002

    • Search Google Scholar
    • Export Citation
  • 28.

    Pollock BEFlickinger JCLunsford LDMaitz AKondziolka D: Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:123912471998Pollock BE Flickinger JC Lunsford LD Maitz A Kondziolka D: Factors associated with successful arteriovenous malformation radiosurgery. Neurosurgery 42:1239–1247 1998

    • Search Google Scholar
    • Export Citation
  • 29.

    Pollock BEGorman DACoffey RJ: Patient outcomes after arteriovenous malformation radiosurgical management: results based on a 5- to 14-year follow-up study. Neurosurgery 52:129112972003Pollock BE Gorman DA Coffey RJ: Patient outcomes after arteriovenous malformation radiosurgical management: results based on a 5- to 14-year follow-up study. Neurosurgery 52:1291–1297 2003

    • Search Google Scholar
    • Export Citation
  • 30.

    Pollock BEKondziolka DFlickinger JCPatel AKBissonette DJLunsford LD: Magnetic resonance imaging: an accurate method to evaluate arteriovenous malformations after stereotactic radiosurgery. J Neurosurg 85:104410491996Pollock BE Kondziolka D Flickinger JC Patel AK Bissonette DJ Lunsford LD: Magnetic resonance imaging: an accurate method to evaluate arteriovenous malformations after stereotactic radiosurgery. J Neurosurg 85:1044–1049 1996

    • Search Google Scholar
    • Export Citation
  • 31.

    Schwartz MSixel KYoung CKemeny AForster DWalton LPrediction of obliteration of arteriovenous malformations after radiosurgery: the obliteration prediction index. Can J Neurol Sci 24:1061091997Schwartz M Sixel K Young C Kemeny A Forster D Walton L Prediction of obliteration of arteriovenous malformations after radiosurgery: the obliteration prediction index. Can J Neurol Sci 24:106–109 1997

    • Search Google Scholar
    • Export Citation
  • 32.

    Soderman MAndersson TKarlsson BWallace MCEdner G: Management of patients with brain arteriovenous malformations. Eur J Radiol 46:1952052003Soderman M Andersson T Karlsson B Wallace MC Edner G: Management of patients with brain arteriovenous malformations. Eur J Radiol 46:195–205 2003

    • Search Google Scholar
    • Export Citation
  • 33.

    Souhami LOlivier APodgorsak EBPla MPike GB: Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 19:7757821990Souhami L Olivier A Podgorsak EB Pla M Pike GB: Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 19:775–782 1990

    • Search Google Scholar
    • Export Citation
  • 34.

    Spetzler RFMartin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:4764831986Spetzler RF Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483 1986

    • Search Google Scholar
    • Export Citation
  • 35.

    Yamamoto YCoffey RJNichols DAShaw EG: Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. J Neurosurg 83:8328371995Yamamoto Y Coffey RJ Nichols DA Shaw EG: Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size dose time and technical factors on obliteration rate. J Neurosurg 83:832–837 1995

    • Search Google Scholar
    • Export Citation
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