Includes sensorimotor, language, or visual cortex; internal capsule; brainstem; thalamus; or hypothalamus.
3. Venous Drainage
Standardized Metric
Spetzler-Martin represents the gold standard in vascular neurosurgery for objectively quantifying the risk of focal neurological deficit.
Vascular Risk Probe
Input the size, eloquence, and venous drainage parameters to determine the Spetzler-Martin grade and surgical risk category.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Grading the surgical risk of intracranial arteriovenous malformations (AVMs).
Selecting patients for microsurgical resection vs. Gamma Knife Radiosurgery vs. embolization.
Predicting the likelihood of post-operative neurological deficits.
Section 2
Literature
Development
Robert Spetzler and Neil Martin published this grading system in 1986. It remains the most widely cited and utilized AVM grading system worldwide because it focuses on the three anatomical variables that most influence surgical mortality and morbidity: size, location relative to eloquent cortex, and the pattern of venous drainage.
Section 3
Pearls/Pitfalls
Deep Venous Drainage
The presence of *any* deep venous drainage component adds 1 full point to the grade. Deep drainage (e.g. into the vein of Galen or internal cerebral veins) implies a significantly more complex and dangerous surgical dissection compared to AVMs that drain solely into cortical surface veins.
Section 4
Evidence Appraisal
Primary Reference
A proposed grading system for arteriovenous malformations
Spetzler RF et al. • J Neurosurg. 1986;65(4):476-83
