The Spetzler-Martin scale is the most commonly used AVM gradation system in clinical practice. However, it is important to understand that the Spetzler-Martin scale is a surgical scale that categorizes AVMs by predicting the likelihood of satisfactory surgical outcome and, therefore, has little practical value for alternate therapeutic options, such as embolization and radiosurgery. The Spetzler-Martin grade of an AVM is determined by summing three individual scores. For the first score, based on size (as determined by measuring the largest diameter of the nidus on angiography), 1 is given for an AVM < 3 cm, 2 for an AVM between 3 and 6 cm, and 3 for an AVM > 6 cm. For the second score, based on the eloquence (i.e., the functional importance of the adjacent brain tissue), 1 is given if the AVM is adjacent to eloquent tissue, 0 is attributed if it is not. Eloquent areas of brain tissue include sensorimotor, visual, and language areas, as well as thalamus, hypothalamus, internal capsule, brain stem, cerebellar peduncles, and deep cerebel-lar nuclei. The third score depends on whether the venous drainage of the AVM is superficial (score of 0) or has a deep component (score of 1). The sum of the three partial scores ranges between 1 and 5, the highest grades being associated with increased difficulty in surgical resection and poor surgical outcome (15).
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