According to the Spetzler-Martin classification (S-M classification), high-grade intracranial arteriovenous malformation (AVM) refers to AVM of grade IV-VI_1 J. It is difficult to treat, with a high rate of surgical disability and death and a poor final outcome. It is one of the problems that plague neurosurgeons. We treated 23 patients with high-grade AVM (37% of AVM in the same period, 23/63) and achieved good results. The treatment strategies and outcomes of high-grade intracranial AVMs are reported below.