Is Supplemented Spetzler-Martin grading Superior? A comparative study in AVM microsurgery risk stratification

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-10 DOI:10.1016/j.jocn.2025.111311

Cyrus Raki , Chris Xenos , Leon T. Lai

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引用次数: 0

Abstract

The Spetzler-Martin (SM) grading system remains the most widely adopted classification for brain arteriovenous malformations (AVMs). The Supplemented Spetzler-Martin (Supp-SM) system was developed to improve surgical risk stratification by incorporating patient age, rupture status, and nidus diffuseness. However, data comparing its predictive validity remain limited. This study investigates the predictive relevance of SM and Supp-SM grading for postoperative neurological morbidity following AVM microsurgery at a single tertiary cerebrovascular centre.

A retrospective review identified 96 patients who underwent AVM microsurgical resection, with or without preoperative embolisation, between 2015 and 2024. Postoperative morbidity was defined as worsened modified Rankin Scale (mRS) score at 90 days. Predictive accuracy was analysed using ROC curves, correlation with postoperative mRS scores, and Supp-SM risk threshold.

Postoperative morbidity occurred in 9 patients (9.4 %). ROC analysis revealed no significant difference between SM (AUROC 0.717; 95 % CI 0.55–0.88) and Supp-SM (AUROC 0.667; 95 % CI 0.46–0.88) scores, p = 0.3899. However, Supp-SM scores demonstrated a stronger correlation with postoperative mRS changes (Spearman’s ρ = 0.269, p = 0.008) than SM grades (Spearman’s ρ = 0.144, p = 0.161). Patients with Supp-SM grades < 6 had a 3.2 % morbidity risk, compared with a 20.6 % risk for scores ≥ 6 (p = 0.009). A Supp-SM threshold of 6 demonstrated the highest discriminative accuracy in differentiating high- and low-risk surgical candidates.

While no significant predictive difference was found between SM and Supp-SM grading, a Supp-SM score of ≥ 6 was associated with substantially higher morbidity. These findings support the adjunctive use of Supp-SM grading for surgical risk assessment in AVM patients.

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补充斯佩茨勒-马丁评分是否更高？动静脉畸形显微手术风险分层的比较研究

Spetzler-Martin （SM）分级系统仍然是脑动静脉畸形（avm）最广泛采用的分类方法。采用补充的Spetzler-Martin （Supp-SM）系统，结合患者年龄、破裂状态和病灶弥漫性，改善手术风险分层。然而，比较其预测有效性的数据仍然有限。本研究探讨了SM和Supp-SM分级对单一三级脑血管中心AVM显微手术后神经系统疾病的预测相关性。一项回顾性研究发现，在2015年至2024年期间，有或没有术前栓塞的96例患者接受了动静脉畸形显微手术切除。术后发病率定义为90天改良兰金量表（mRS）评分恶化。采用ROC曲线、与术后mRS评分的相关性和sup - sm风险阈值分析预测准确性。术后发病9例（9.4%）。ROC分析显示两组间差异无统计学意义(AUROC 0.717；95% CI 0.55-0.88)和Supp-SM (AUROC 0.667；95% CI 0.46-0.88)评分，p = 0.3899。然而，Supp-SM评分与术后mRS变化的相关性（Spearman 's ρ = 0.269, p = 0.008）高于SM评分（Spearman 's ρ = 0.144, p = 0.161）。Supp-SM分级患者<；6分患者的发病风险为3.2%，而评分≥6分患者的发病风险为20.6% （p = 0.009）。Supp-SM阈值为6，表明在区分高风险和低风险手术候选人方面具有最高的判别准确性。虽然SM和Supp-SM评分之间没有显著的预测差异，但Supp-SM评分≥6与更高的发病率相关。这些发现支持辅助使用Supp-SM分级对AVM患者进行手术风险评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.