Predictive Capability of the Spetzler-Martin versus Supplementary Grading Scale for Microsurgical Outcomes of Cerebellar Arteriovenous Malformations
A 16-year-old female presented with sudden onset headache, nausea, and vomiting followed rapidly by coma. Brain computed tomography (CT) showed a large cerebellar hematoma resulting in tonsillar herniation and obstructive hydrocephalus. CT angiography (CTA) showed a left tentorial AVM measuring 12×8 mm in the middle cerebellar peduncle supplied by the left superior cerebellar artery (SCA) and anterior inferior cerebellar arteries (AICA) and draining into the left transverse and straight sinuses (). The AVM was Spetzler-Martin grade II and supplementary grade I. Due to compression of the brain stem by the hematoma, the patient was taken emergently to the operating room in order to undergo suboccipital craniectomy and AVM resection. No residual nidus was observed on post-operative digital subtraction angiography (DSA). The patient had transient abducens and facial nerve palsies, which had resolved at the time of discharge. At 2-month follow-up, the patient had mild dysmetria and intermittent diplopia but had returned to playing softball.