If higher grade of a patient with ICAVM suggests a poorer prognosis, how and why did most of our patients with high grades survive?
Different managements in patients with ICAVM may have variable prognosis.
The Spetzler-Martin grading scale (SMGS) system, containing three parameters including the lesion size, pattern of venous drainage, and neurological eloquence of the adjacent brain, [sup] is widely used for accessing the risk of surgery and a consensus therapeutic guideline in adult patients with ICAVMs. Literature suggests that accessible, low-grade (Spetzler-Martin grade 1-3) AVMs are often best managed with surgery; [sup],,,, low-grade, but inaccessible AVMs or those in eloquent locations are often treated with stereotactic radiosurgery (SRS), [sup] and the management of high-grade (Spetzler-Martin grade 4-5) AVMs has no conclusion, [sup], suggesting that different managements may link to patients' prognoses.
We used the International Classification of Diseases, 9 [sup]th revision, Clinical Modification (ICD-9-CM) code 747.81 to review the charts of pediatric patients (<18 years of age) who were consecutively admitted to one medical center in Taipei, Taiwan for congenital ICAVMs from 1991 to 2012.
[sup],,,, ICAVMs are frequently found in the supratentorium in adult patients.