The cure rate of AVMs treated purely endovascularly has been relatively low due to the lack of ideal embolization materials. For a long time, people have been trying to use various embolization materials and techniques to treat cerebral AVM, and the materials used to embolize cerebral AVM include various solid particles, silk thread, alcohol, microspring coils, etc., but they are only used for pre-surgical embolization because of unreliable embolization effect and high recanalization rate, and cannot be used as permanent embolization. At present, a liquid embolic agent is widely used in clinical practice: n-butyl cyanoacrylate (NBCA), which can polymerize after contact with blood, thus playing the effect of permanent embolization. However, NBCA has high handling requirements, risk of mucosal tubing, and cannot be injected for a long period of time, so the efficacy of NBCA for larger cerebral AVM embolization is still very unsatisfactory. Previous literature reports that the cure rate of NBCA embolization alone is only 4% to 7.7%. For giant cerebral arteriovenous malformations, NBCA embolization often requires repeated embolization to achieve the standard of radiosurgery treatment, which is a long treatment period and expensive. In recent years, Onyx, a new liquid embolic agent, has been used in clinical practice to improve the cure rate of cerebral AVMs. Onyx is a simple mixture of ethylene vinyl alcohol copolymer (EVOH) dissolved in dimethyl sulfoxide (DMSO) with the addition of micronized tantalum powder to make it visible on x-ray. onyx does not stick to the catheter and can be injected slowly over a long period of time to achieve good dispersion within the malformed mass. The authors’ preliminary results suggest that Onyx embolization alone may result in early imaging cure in 20% of patients, with long-term results to be further observed. For giant cerebral arteriovenous malformations, the standard of radiosurgical treatment can be achieved with one to two Onyx embolizations, significantly shortening the treatment period and reducing treatment costs. In addition, through angiographic follow-up of patients treated with Onyx embolization, the authors found that the possibility of recanalization and recurrence was reduced because Onyx embolization achieved perfusion of the malformation mass with embolic agents. Therefore, the authors concluded that Onyx is by far the better embolization material for the treatment of cerebral arteriovenous malformations, extending the indications for interventional treatment of cerebral arteriovenous malformations and promising to improve the efficacy of interventional treatment of cerebral arteriovenous malformations. However, the complication rate of 10%-20% is one of the main concerns of neurointerventionalists when choosing endovascular embolization. It is our continuous pursuit to master the Onyx technique for embolization of cerebral AV malformations and to minimize the complication rate. To summarize the Onyx embolization treatment of more than 300 cases of cerebral AVM, we have gained the following experiences: (1) Choose the target vessel as thick as possible and allow proper regurgitation of the blood supply artery; (2) The microcatheter should be super-selected to enter the arteriovenous malformation cluster; (3) Choose a good working angle so that the diffusion of Onyx can be well observed and regurgitation can be detected in time; (4) Adopt the “block and (5) Pay attention to the timing of extubation and the handling of indwelling microcatheters; (6) Giant cerebral AVM can be embolized in stages or in phases, and if a large volume is embolized at one time, postoperative hypotensive treatment should be maintained for 24 h; (7) It is important to note that intraoperative Onyx reflux has a “double-edged sword” effect on the outcome of treatment. (7) It should be noted that intraoperative Onyx reflux has a “double-edged sword” effect on the outcome. On the one hand, moderate regurgitation facilitates the continuous pushing of Onyx into the malformed mass to achieve a satisfactory embolic effect; on the other hand, inappropriate regurgitation can cause difficulties in extubation and serious cerebral hemorrhage, resulting in life-threatening and serious sequelae for the patient. We believe that the degree of tortuosity of the blood supply artery is the primary factor leading to the difficulty of extubation. Therefore, Onyx embolization is not recommended for significantly tortuous and small blood supply arteries, and if necessary, it is safer to leave a microcatheter in place after embolization is completed. Other conditions that may not be suitable for Onyx embolization are: (1) arteriovenous fistulas with very high flow; (2) AVMs with only small deep penetrating branches, such as arteriovenous malformations of the brainstem; and (3) arteriovenous malformations of the spinal cord. It should be noted that the efficacy of embolization of cerebral AVM is not only related to the characteristics of the embolization material selected and the embolization technique used, but also closely related to the complexity of the structure of cerebral AVM and individual differences, especially we cannot fully grasp the cerebral hemodynamic changes that occur during and after the embolization of cerebral AVM, so more basic research and clinical practice are needed to expect embolization to completely cure cerebral AVM.