title: Cerebellar arteriovenous malformations:  anatomic subtypes, surgical results, and increased predictive accuracy of the supplementary grading system.
abstract: BACKGROUND
  Anatomic diversity among cerebellar arteriovenous malformations (AVMs) calls for a classification that is intuitive and surgically informative. Selection tools like the Spetzler-Martin grading system are designed to work best with cerebral AVMs but have shortcomings with cerebellar AVMs.
  
  
  OBJECTIVE
  To define subtypes of cerebellar AVMs that clarify anatomy and surgical management, to determine results according to subtypes, and to compare predictive accuracies of the Spetzler-Martin and supplementary systems.
  
  
  METHODS
  From a consecutive surgical series of 500 patients, 60 had cerebellar AVMs, 39 had brainstem AVMs and were excluded, and 401 had cerebral AVMs.
  
  
  RESULTS
  Cerebellar AVM subtypes were as follows: 18 vermian, 13 suboccipital, 12 tentorial, 12 petrosal, and 5 tonsillar. Patients with tonsillar and tentorial AVMs fared best. Cerebellar AVMs presented with hemorrhage more than cerebral AVMs (P < .001). Cerebellar AVMs were more likely to drain deep (P = .04) and less likely to be eloquent (P < .001). The predictive accuracy of the supplementary grade was better than that of the Spetzler-Martin grade with cerebellar AVMs (areas under the receiver-operating characteristic curve, 0.74 and 0.59, respectively). The predictive accuracy of the supplementary system was consistent for cerebral and cerebellar AVMs, whereas that of the Spetzler-Martin system was greater with cerebral AVMs.
  
  
  CONCLUSIONS
  Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an aggressive treatment posture. The supplementary system is better than the Spetzler-Martin system at predicting outcomes after cerebellar AVM resection. Key components of the Spetzler-Martin system such as venous drainage and eloquence are distorted by cerebellar anatomy in ways that components of the supplementary system are not.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143-0112, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Hernández
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.forename: Tony
authors.initials: T
authors.lastname: Pourmohamad
authors.forename: William L
authors.initials: WL
authors.lastname: Young
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001165:Arteriovenous Malformations / Q000145:classification / Q000473:pathology / Q000601:surgery; D002531:Cerebellum / Q000473:pathology* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult