rteriovenous malformations (AVMs) are vascular abnormalities that onsist of multiple fistulous connections between arteries and veins ithout a normal intervening capillary bed. AVMs are thought to be ongenital. Ninety percent of all AVMs are supratentorial. The most ommon presentation of an AVM is intracerebral hemorrhage (ICH). eizure is the second most common presentation. Other symptoms nclude headache and neurological deficits related to steal phenomena or ther alteration in tissue perfusion adjacent to the AVM. To appropriately manage AVMs, it is important to understand the atural history of these vascular malformations. The decision for no reatment or for a singleor multimodality treatment paradigm also nvolves being familiar with the outcomes and risks of each treatment odality—microvascular resection, endovascular embolization, and steeotactic radiosurgery. Patient-related factors, such as age, general medcal condition, neurologic condition, occupation, and lifestyle, must also e considered. The treatment of AVMs is highly individualized. There is o universal algorithm or protocol to be followed when dealing with these nique and challenging lesions. The current treatment of AVMs includes microsurgical resection alone, reoperative endovascular embolization followed by microsurgical resecion, stereotactic radiosurgery alone, preprocedural endovascular emboization followed by radiosurgery, endovascular embolization only, and bservation only. The only way to achieve cure is with complete bliteration of the AVM. Microsurgical resection, whenever it can be one safely, is the gold standard treatment and other methods of treatment ust be measured against it. There is a well-established role for djunctive endovascular embolization of certain AVMs. Clearly, there are pecific situations, such as small deep AVMs in eloquent brain structures, here microsurgery should not be used as the primary treatment modal-