Workup/Staging

Question 1

What are the common presenting signs of AVMs?

Answer 1

Intracerebral hemorrhage (42%–72%) > seizures (11%–33%) > HA > focal neurologic deficit. Children are more likely to present with hemorrhage than adults.

Question 2

What imaging modality is ideal to r/o a bleed?

Answer 2

CT is ideal to r/o cerebral bleeds.

Question 3

What is the gold standard imaging modality for AVMs?

Answer 3

Angiography is the gold standard modality for imaging AVMs.

Question 4

What other imaging modalities can be used for AVMs? What are their advantages?

Answer 4

CT angiography (good vascular detail), MR angiography (good anatomy detail), functional MRI (eloquent areas), and diffusion tensor imaging (for white matter tracts)

Question 5

What scale is used to evaluate AVM pts for Sg?

Answer 5

Spetzler–Martin scale/grading system (totals possible: I–V)

Question 6

What 3 AVM characteristics in the Spetzler–Martin scale are predictive of surgical outcomes?

Answer 6

AVM characteristics that predict surgical outcome:

Diameter (≤3 cm = 1, 3.1–6.0 cm = 2, >6 cm = 3)
Location (noneloquent area = 0, eloquent area = 1)
Pattern of venous drainage (superficial = 0, deep = 1)

Question 7

How does AVM diameter/size scoring correlate with surgical outcomes?

Answer 7

The smaller the AVM diameter/size (<3 cm), the better the outcomes.

Question 8

What brain areas are considered eloquent?

Answer 8

Eloquent areas include sensorimotor, language, visual, thalamus, hypothalamus, internal capsule, brainstem, cerebellar peduncles, and deep cerebellar nuclei.