The Spetzler-Martin classification of this lesion was 2 (out of 5 possible points) based on location (eloquent cortex, i.e.. visual, language, 1 point), drainage (superficial, 0, deep, 1), and size (0-3cm, 1, 3-6cm, 2, >6, 3). The neurological outcome of surgery is inversely proportional to the score, 1 being the best.
Because of the 4%/year risk of hemorrhage and 10% mortality (and much higher risk of permanent neurologic damage) with each bleed, therapeutic intervention was recommended for this young woman. Surgery was chosen over radiation because the radiation effect takes 3-4 years to close down the malformation, during which time the patient is still at risk for bleeding. In addition, there can be collateral neurologic damage from the radiation. The patient underwent pre-operative embolization of the lesion to decrease vascularity and lower the risk of surgery.
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