title: A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score.
abstract: BACKGROUND
  The Spetzler-Martin arteriovenous malformation (AVM) grading system has proven to be useful in guiding treatment of cerebral AVMs with craniotomy. It is based on anatomical characteristics each of which makes surgical resection of an AVM more difficult, namely, deep venous drainage, eloquence of surrounding tissue, and large nidus size. A higher score correlates with more complications after treatment. Although this grading system has proven reliable over time, it does not reflect the major determinants of risk associated with endovascular treatment. The authors developed a grading system unique to endovascular treatment of cerebral AVMs.
  
  
  METHODS
  The proposed grading system accounts for the principal AVM anatomical and physiological features that make endovascular embolization more difficult and, thus, the likelihood of complications greater. These include number of arterial pedicles, diameter of arterial pedicles, and eloquent location of AVM nidus. The proposed grading system was retrospectively applied to 50 patients undergoing endovascular AVM embolization, and its ability to predict complications was compared to the Spetzler-Martin grading system.
  
  
  RESULTS
  Perioperative complications among the 50 patients included 4 major and 9 minor complications. The proposed grading system was predictive of complication risk, with an increasing rate of perioperative complications associated with an increasing AVM grade. An improved correlation of perioperative complication incidence was noted with the proposed system (P = 0.002), when compared with the Spetzler-Martin grading system (P = 0.33).
  
  
  CONCLUSIONS
  This grading system for the endovascular treatment of AVMs is simple, easily reproduced, and clinically valuable.
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Division of Neurosurgery, Department of Surgery, The University of Arizona, Tucson, Arizona, USA.
authors: Travis M
authors: TM
authors: Dumont
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
authors: Peter
authors: P
authors: Kan
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA.
authors: Kenneth V
authors: KV
authors: Snyder
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Jacobs Institute, Buffalo, New York, USA.
authors: L Nelson
authors: LN
authors: Hopkins
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Jacobs Institute, Buffalo, New York, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA.
authors: Elad I
authors: EI
authors: Levy
keywords: Cerebral arteriovenous malformations; complications; endovascular glue embolization
references: Neurosurgery. 2008 Aug;63(2):239-43; discussion 243
references: 18797353
references: Neurosurg Clin N Am. 2009 Oct;20(4):399-418
references: 19853800
references: Stroke. 2002 Jul;33(7):1816-20
references: 12105359
references: J Neurosurg. 2002 Jan;96(1):79-85
references: 11794608
references: J Neurosurg. 2010 Oct;113(4):715-22
references: 19835467
references: J Neurosurg. 1986 Oct;65(4):476-83
references: 3760956
references: JAMA. 2011 Nov 9;306(18):2011-9
references: 22068993
references: Neurosurgery. 1994 Jan;34(1):2-6; discussion 6-7
references: 8121564
references: World Neurosurg. 2011 Sep-Oct;76(3-4):276-81
references: 21986424
references: P R Health Sci J. 2010 Jun;29(2):117-20
references: 20496526
references: Neurosurgery. 2006 Apr;58(4):602-11; discussion 602-11
references: 16575323
references: Neurosurgery. 2006 Jul;59(1):53-9; discussion 53-9
references: 16823300
references: J Neurosurg. 2006 Feb;104(2):226-32
references: 16509496