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Abstract
Arteriovenous malformations (AVMs) represent one of the most complex lesions encountered by the vascular neurosurgeon. They are thought to arise by a developmental aberration early in fetal life leading to structurally abnormal vessels, characterised by arteriovenous shunting. AVMs may present in a number of ways, the most devastating being hemorrhage. Their natural history, particularly hemorrhage risk, has been extensively studied and is crucial in informing management decisions. The primary goal of treatment is to eliminate hemorrhage risk. Success in treating these lesions involves comprehensive evaluation of the lesions to balance the risk of haemorrhage against the risk of treatment. Thus, first the decision whether to treat is made followed by selecting the optimum modality of treatment. Successful surgical treatment of AVMs requires extensive preoperative planning and meticulous microsurgical technique.