Predictive Capability of the Spetzler-Martin versus Supplementary Grading Scale for Microsurgical Outcomes of Cerebellar Arteriovenous Malformations
A 59 year-old female was found unresponsive. Brain CT showed a subarachnoid hemorrhage and fourth ventricular hemorrhage resulting in obstructive hydrocephalus necessitating placement of an emergent external ventricular drain. DSA showed a right cerebellar AVM measuring 14×15×13 mm supplied by the bilateral SCAs and posterior inferior cerebellar arteries (PICA) with multiple perinidal aneurysms arising from the feeding right PICA (). The AVM was Spetzler-Martin Grade II and supplementary grade III. Endovascular embolization with polyvinyl alcohol (PVA) and occlusion of the right PICA proximal to the aneurysms was performed prior to surgical resection. The patient subsequently underwent suboccipital craniectomy for AVM resection. The patient's post-operative course was notable for persistent dysphagia requiring placement of a gastrostomy tube, placement of a ventriculoperitoneal shunt, and subclavian thrombus necessitating long-term anticoagulation. The patient was discharged to a nursing home after three weeks of hospitalization.