Cranial Gamma Knife has been used to treat cerebral arteriovenous malformations (AVM) for more than thirty years, and a large number of cases and experience have been accumulated both at home and abroad, and cerebrovascular malformations have long been one of the main targets of Cranial Gamma Knife treatment. Because cranial gamma knife treatment AVM efficacy is reliable and good, so in a broad sense cranial gamma knife can treat any part of the cranial AVM, but clinically it can not be so simple to think that not every AVM patients are the most suitable treatment method of gamma knife. As we already know, the main treatment methods for AVM are micro-neurosurgical resection, intravascular embolization therapy and cranial gamma knife. The author believes that for each individual AVM patient encountered in the clinic, the neurosurgeon should first consider the following when choosing the treatment method, namely, the site, size, blood supply relationship, bleeding history, symptoms and signs, age, and acceptance of the treatment, etc., and then make objective efficacy prediction and assessment for each of the three treatments, which mainly includes efficacy, risk, disability rate, and mortality, etc. The assessment includes efficacy, risk, disability, and mortality, which are summarized as safety and efficacy. In general, gamma knife is the safest treatment for AVM, without the complications specific to surgery and embolization. Even for AVM in specific sites, the risk is less than the other two treatments. The efficacy of Gamma Knife for AVM has been confirmed by a large number of cases at home and abroad, and is relatively ideal. The main factor affecting the efficacy is the size of AVM, at present, scholars at home and abroad are more unanimous that medium-sized and small AVM, Gamma Knife can be the preferred treatment method. For large AVM, treatment with gamma knife alone is obviously worse than medium-sized and small, and the complication rate is also higher. It is advocated to first treat with endovascular embolization, and then treat the residual part with gamma knife. Alternatively AVMs that are not occluded after gamma knife treatment or AVMs that bleed during the observation period can be removed craniotomically. This way two or more therapies treat and complement each other, reducing the risk of a single therapy and improving the overall efficacy, which is a better treatment plan at present. We have tried gamma knife segmentation therapy for large AVMs that cannot be craniotomized, and the long-term observation of the efficacy is satisfactory and does not increase the worrying problem of severe cerebral edema and hemorrhage. In conclusion, gamma knife treatment of AVM is safe and reliable, and its interaction with endovascular embolization therapy and microsurgery can undoubtedly further improve the overall efficacy and safety of AVM. In summary, the indications for head gamma knife treatment of AVM are: (1) small and medium-sized AVM with a diameter of less than 4 cm, especially those located in important functional brain areas and deep brain.(2) residual AVM after craniotomy and residual AVM after intravascular embolization treatment.(3) small and medium-sized AVM after three months of hemorrhage.(4) elderly and frail people or those who cannot tolerate general anesthesia or craniotomy due to serious diseases of other important organs. craniotomy. (5) Large AVMs that cannot be operated or are not suitable for embolization treatment for various reasons or AVMs that are still large after repeated embolization may be considered for cranial gamma knife volume splitting treatment.