The Application of the Novel Grading Scale (Lawton-Young Grading System) to Predict the Outcome of Brain Arteriovenous Malformation.
Neurosurgery
; 84(2): 529-536, 2019 02 01.
Article
em En
| MEDLINE
| ID: mdl-29733392
ABSTRACT
BACKGROUND:
A supplementary grading scale (Supplemented Spetzler-Martin grade, Supp-SM) was introduced in 2010 as a refinement of the SM system to improve preoperative risk prediction of brain arteriovenous malformations (AVMs).OBJECTIVE:
To determine the ability to predict surgical outcomes using the Supp-SM grading scale.METHODS:
This retrospective study was conducted on 200 patients admitted to the Helsinki University Hospital between 2000 and 2014. The validity of the Supp-SM and SM grading systems was compared using the area under the receiver operating characteristic (AUROC) curves, with respect to the change between preoperative and early (3-4 mo) as well as final postoperative modified Rankin Scale (mRS) scores.RESULTS:
The performance of the Supp-SM was superior to that of the SM grading scale in the early follow-up (3-4 mo) AUROC = 0.57 (95% confidence interval [CI] 0.49-0.65) for SM and AUROC = 0.67 (95% CI 0.60-0.75) for Supp-SM. The Supp-SM performance continued improving over SM at the late follow-up AUROC = 0.63 (95% CI 0.55-0.71) for SM and AUROC = 0.70 (95% CI 0.62-0.77) for Supp-SM. The perforating artery supply, which is not part of either grading system, plays an important role in the early follow-up outcome (P = .008; odds ratio 2.95; 95% CI 1.32-6.55) and in the late follow-up outcome (P < .001; odds ratio 5.89; 95% CI 2.49-13.91).CONCLUSION:
The Supp-SM grading system improves the outcome prediction accuracy and is a feasible alternative to the SMS, even for series with higher proportion of high-grade AVMs. However, perforators play important role on the outcome.
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Base de dados:
MEDLINE
Assunto principal:
Malformações Arteriovenosas Intracranianas
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Resultado do Tratamento
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article