Microsurgical AVM excision is the most effective treatment currently available. However, not every AVM is amenable to or best treated with surgery. Grading systems, such as the Spetzler-Martin grading system, are intended to predict the risk of neurologic deficit after surgery (Table 20.3) . These surgical risks need to be weighed against the patient's age, clinical condition, vocation, psychological factors and expected natural history. For example, small superficial AVMs in silent cortical locations such as the non-dominant anterior frontal lobe are easily resected with little risk, whereas deep AVMs located in the basal ganglia, ventricular system, medial cortical surfaces or brain stem pose a significantly higher risk of neurologic injury during surgery. Similarly, a Grade III AVM in a 25-year-old patient with seizures
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.