Natural History

The treatment of AVMs is primarily intended to eradicate the risk of potential hemorrhage. The indications and method of invasive treatment of AVMs require a thorough knowledge of AVM natural history and treatment risk. Treatment risk, particularly surgical risk, is defined by a variety of grading systems, the most popular of which is the Spetzler-Martin grading system (Table 20.2) [18]. A predictive grading system for the endovascular management of AVMs is not yet established.

Untreated AVMs have a poor prognosis. For example, Ondra et al. prospectively followed 166 symptomatic but untreated AVM patients [10]. The average follow-up was more than 20 years. During this time, 23% of the patients died from AVM hemorrhage and the combined annual

Table 2G.2. Spetzler-Martin AVM grading system

Variable

Score

Size of nidus

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