AVM

Question 1

Spetzler and Martin Scale

Answer 1

Used to predict morbidity and mortality with surgical resection

1. Location - eloquent vs non eloquent
2. Drainage - deep or superficial
3. Size- <3cm, 3-6 cm, >6cm

Question 2

Define ‘eloquent area’ in the context of the Spetzler and Martin Scale.

Answer 2

Sensorimotor, language, visual cortex, hypothalamus, thalamus, brainstem, cerebellar nuclei

Question 3

Treatment option for AVMs?

Answer 3

Observation
Surgical removal
Radiosurgery - GKSRS
Combination therapy

Question 4

Embolisation therapy

Answer 4

Staged Embolisation: Decrease the risk of post-operative complications
Can be partial - selectively embolise rupture point

Question 5

Benefit surgical removal of an AVM?

Answer 5

Immediate elimination of risk of AVM hemorrhage
Recommended in younger patients with low risk AVM, at risk or prio haemorrhage

Question 6

Gamma Knife Stereotactic Radiosurgery (GKSRS)

Answer 6

Patients with smaller AVMs (3 cm or smaller) in deep or eloquent brain tissue where surgical risk is high (language centre, basal ganglia, thalamus)

Higher obliteration rate in smaller AVMs - 80% in <3cm

Question 7

How long does it typically take for obliteration of the AVM after GKSRS?

Answer 7

1-2 years

Question 8

AVM presenting with ICH

Answer 8

Controlled craniotomy with clot evacuation , then subsequent treatment in a more delayed fashion