# Spetzler-Martin — Spetzler-Martin grading of brain arteriovenous malformations

> Grades brain AVM surgical risk by size, eloquence of adjacent brain, and venous drainage.

**Situação:** vigente · **Órgão:** Encéfalo · **Órgão emissor:** Neurosurgical consensus · **Versão:** 1986 · **Ano:** 1986

## Procedência e vigência
- Família: léxico
- Tipo de lógica: score
- Modalidade: MRI, Angiography
- Fonte primária: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Return the numeric grade together with S/E/V components. Grade VI is a historical expert designation outside the arithmetic sum; the scale is a microsurgical-risk tool, not an automatic treatment rule.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Grade I, numeric score 1 | Numeric total 1: a small nidus below 3 cm (S1), noneloquent adjacent brain (E0), and superficial venous drainage only (V0); the only valid component profile is S1E0V0. | Use grade I as one estimate of risk from open microsurgical resection and retain the S/E/V profile. The grade does not by itself choose observation, surgery, embolization or radiosurgery. | Lowest numeric microsurgical-risk grade in the scale. It predicts operative morbidity and mortality comparatively, not the untreated hemorrhage risk. | Spetzler and Martin 1986, PMID 3760956 abstract: grade I is small, superficial and noneloquent; CNS Clinical Neurosurgery 2011, Table 1: size, eloquence and drainage points. | ✓ |
| II | Grade II, numeric score 2 | Numeric total 2. Valid S/E/V profiles are S1E1V0, S1E0V1 or S2E0V0, where S1 is below 3 cm and S2 is 3-6 cm inclusive. | Use grade II as one estimate of risk from open microsurgical resection and report the actual S/E/V profile. The grade does not by itself choose a treatment modality. | Relatively low numeric microsurgical-risk grade, but different size, eloquence and drainage combinations can produce the same total and remain clinically relevant. | CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: S=1-3, E=0-1 and V=0-1; arithmetic profiles summing to 2. NCBI Bookshelf NBK531479, Spetzler-Martin section. | ✓ |
| III | Grade III, numeric score 3 | Numeric total 3. Valid profiles are S1E1V1, S2E1V0, S2E0V1 or S3E0V0; grade III is therefore anatomically heterogeneous and the component profile must accompany the total. | Use grade III as one estimate of open-microsurgical risk and preserve the S/E/V subtype for multidisciplinary planning. The numeric total alone does not select embolization or any other treatment. | Intermediate numeric microsurgical-risk grade whose risk is not uniform across its component profiles; it is not a measure of spontaneous hemorrhage risk. | CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; the four listed profiles are the complete arithmetic combinations summing to 3. | ✓ |
| IV | Grade IV, numeric score 4 | Numeric total 4. Valid profiles are S2E1V1, S3E1V0 or S3E0V1, combining a medium or large nidus with eloquence and/or deep venous drainage. | Treat grade IV as a high open-microsurgical-risk descriptor and retain the S/E/V profile. Final management requires individualized neurovascular review and is not dictated by the grade alone. | High numeric risk for morbidity and mortality from open microsurgical resection; the scale does not directly estimate embolization, radiosurgery or natural-history risk. | CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; NCBI Bookshelf NBK531479 states that perioperative risk increases with grade and does not necessarily transfer to other modalities. | ✓ |
| V | Grade V, numeric score 5 | Numeric total 5, the maximum additive score: large nidus above 6 cm (S3), eloquent adjacent brain (E1), and any deep venous drainage (V1), profile S3E1V1. | Treat grade V as the highest numeric open-microsurgical-risk descriptor and retain the S/E/V profile. Final management requires individualized neurovascular review and is not dictated by the grade alone. | Highest numeric microsurgical-risk grade. The original article characterizes grade V as large, deep and neurologically critical, without making it a patient-specific probability. | Spetzler and Martin 1986, PMID 3760956 abstract: grade V lesions are large, deep and in neurologically critical areas; CNS Clinical Neurosurgery 2011, Table 1: maximum profile S3E1V1. | ✓ |
| VI | Grade VI, historical non-numeric designation for an essentially inoperable AVM | Historical special designation from the original publication for an AVM judged essentially inoperable. Grade VI is an expert designation outside the 1-5 additive S/E/V calculation and cannot be generated by summing points. | Do not calculate grade VI from imaging points or treat the label as an automatic no-treatment command. If the historical designation is used, state that it is non-numeric and requires specialist neurovascular judgment. | The original designation represents operative concern beyond numeric grade V, but it supplies no separate quantitative risk estimate and does not measure natural-history hemorrhage risk. | Spetzler and Martin 1986, PMID 3760956 abstract: all AVMs were described in six grades and grade VI as essentially inoperable; NCBI Bookshelf NBK531479 distinguishes numeric grades I-V from the special grade VI designation. | ✓ |

### Citações por categoria
- **I**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · Spetzler and Martin 1986, PMID 3760956 abstract: grade I is small, superficial and noneloquent; CNS Clinical Neurosurgery 2011, Table 1: size, eloquence and drainage points.
- **II**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: S=1-3, E=0-1 and V=0-1; arithmetic profiles summing to 2. NCBI Bookshelf NBK531479, Spetzler-Martin section.
- **III**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; the four listed profiles are the complete arithmetic combinations summing to 3.
- **IV**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · CNS Clinical Neurosurgery 2011, Table 1 reproduced from Spetzler and Martin: component points and additive grade; NCBI Bookshelf NBK531479 states that perioperative risk increases with grade and does not necessarily transfer to other modalities.
- **V**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · Spetzler and Martin 1986, PMID 3760956 abstract: grade V lesions are large, deep and in neurologically critical areas; CNS Clinical Neurosurgery 2011, Table 1: maximum profile S3E1V1.
- **VI**: Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations (1986) — https://doi.org/10.3171/jns.1986.65.4.0476 · Spetzler and Martin 1986, PMID 3760956 abstract: all AVMs were described in six grades and grade VI as essentially inoperable; NCBI Bookshelf NBK531479 distinguishes numeric grades I-V from the special grade VI designation.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 1986-10-01 | published | Spetzler-Martin AVM grading proposed. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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