Spetzler-Martin Grade 

Updated: Sep 12, 2014
  • Author: Stavropoula I Tjoumakaris, MD; more...
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Spetzler-Martin Grade

The Spetzler-Martin arteriovenous malformation (AVM) grading system was described as a method of estimating the mortality and morbidity of surgical resection to guide treatment recommendations. It allocates points for various features of intracranial AVMs, including size, eloquent location, and venous drainage. [1]

Size of nidus

  • 1 point = Small (< 3 cm)
  • 2 points = Medium (3-6 cm)
  • 3 points = Large (>6 cm)

Eloquence of adjacent brain

  • 0 points = Noneloquent (frontal and temporal lobe, cerebellar hemispheres)
  • 1 point = Eloquent (sensorimotor, language, visual cortex, hypothalamus, thalamus, brain stem, cerebellar nuclei, or regions directly adjacent to these structures)

Venous drainage

  • 0 points = Superficial only
  • 1 point = Deep

The Spetzler-Martin grade was originally validated in a study of 100 consecutive patients treated with microsurgical excision of AVMs. Morbidity rates were as follows:

  • Grade 1: 0%
  • Grade 2: 5% minor deficit, 0% major deficit
  • Grade 3: 12% minor deficit, 4% major deficit
  • Grade 4: 20% minor deficit, 7% major deficit
  • Grade 5: 19% minor deficit, 12% major deficit