Virginia Radiosurgery AVM Scale (VRAS)
The VIRGINIA RADIOSURGERY AVM SCALE (Starke and colleagues 2013) predicts the outcome of stereotactic radiosurgery for a brain arteriovenous malformation, scoring 0 to 4.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- AVM volume
- 5 cm^3
- Eloquent location
- Yes
- Prior hemorrhage
- Yes
Result: 4
The tool opens with these values already filled in. Replace them with your own.
What the result means
- 0 to 1
- 80% favorable outcome.
- 2
- 70% favorable outcome.
- 3 to 4
- 45% favorable outcome.
- Granularity
- FIVE scores, THREE published bands. A 0 and a 1 share a figure, as do a 3 and a 4. Never invent a per-score rate.
- Volume weight
- Volume is the ONLY graded item and carries HALF the scale. A large quiet AVM scores 2, exactly like a tiny eloquent one that bled.
- Saturation
- The volume item SATURATES above 4 cm^3: a 5 and a 40 cm^3 AVM are identical here, but 3.5 points apart on Pollock-Flickinger.
- Not convertible
- The two scales share ONLY volume. This uses eloquence + prior hemorrhage; the other uses age + location tier.
- Favorable
- A COMPOSITE: obliteration AND no post-treatment hemorrhage AND no permanent symptomatic radiation complication. NOT the obliteration rate.
- Scope
- Radiosurgical outcome only. Does not choose the modality; ARUBA found medical management superior for UNRUPTURED AVMs.
What you enter
- AVM volume.
- Eloquent location.
- Prior hemorrhage.
Full field descriptions
- AVM volume. Banded, not continuous: Less than 2 cm^3 = 0; 2 to 4 cm^3 = 1; More than 4 cm^3 = 2. IT SATURATES above 4 cm^3.
- Eloquent location. 1 point - half the weight volume can carry.
- Prior hemorrhage. 1 point. The companion score does not use this variable at all.
How this is calculated
- Items
- Volume under 2 cm^3 = 0, 2-4 = 1, over 4 = 2; eloquent location = 1; prior hemorrhage = 1. Total 0-4.
Starke RM, Yen CP, Ding D, Sheehan JP. A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients. J Neurosurg. 2013;119(4):981-987. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.