Intracranial arteriovenous malformation ( A V Ms ) is a congenital vascular malformation. The formation of a coiled vascular mass between the arteries and veins and the lack of a normal capillary bed, as well as the high pressure caused by the abundant blood supply, make the lesion easy to rupture and bleed, resulting in serious consequences. The annual bleeding rate of AVMs is 2-4%, and the lifetime risk of bleeding is 1 7%-9 0%. For patients with a history of bleeding, the risk of recurrent bleeding increases to 6%-18% within 1 year after the first bleeding. Risk factors generally considered to be associated with bleeding include small size, high flow, single venous drainage, concomitant aneurysm, and venous dilatation. In cases with a history of bleeding and significant symptoms, an aggressive treatment strategy should be adopted; in patients without symptoms, the academic opinion is divided as to whether to treat or not. For patients who need intervention, the main treatment tools include microsurgery, endovascular embolization and stereotactic radiosurgery. The main factors related to the risk of surgery include the site, volume and drainage of the lesion, and the commonly used risk rating system is the S p e t z l e r-Ma r t i n classification. For lesions of grades I and II, domestic reports of complete surgical resection rates of up to 8 9 3 %-1 0 0 % with no or only minor complications have been reported, whereas in cases of grades III and above, complications and mortality from surgery alone are significantly higher and the rate of complete resection decreases significantly. The follow-up data of the bulk of cases showed that the good prognosis rates of grades III-V were 88.6%, 73% and 57.1%, respectively, and the overall postoperative neurological deficits were 1 7.1%, including hemiparesis 7.6%, aphasia 3.3%, hemianopia 2.3% and cerebral neurological deficits 3.9%. The prognosis for surgical resection of grade I and II lesions is up to 9.2% -10.0% and 9.4%-9.5%, respectively, which is a good range for surgery. In a comparative study at the University of California, the prognosis was 87% and 54% for compact and loose lesions, respectively, and 78% and 64% for non-deep-penetrating and deep-penetrating lesions, respectively. The lesions with loose conformation and deep penetrating blood supply were significant risk factors for surgical treatment. In conclusion, grade I and II lesions with a history of hemorrhage and acceptable surgical risk are good indications for surgery, whereas for grade I and II lesions with unacceptable surgical risk and grade III-V lesions requiring treatment, endovascular embolization or radiosurgery should be considered on a case-by-case basis to determine individualized interventions. For A V M s lesions in the cerebellum, occupancy effects and blood steal symptoms are indications for surgery, and a combination of endovascular treatment and radiosurgery is the way forward to improve the overall outcome. For A V M s in superficial parts of the brainstem, radiosurgery should be the first choice. II. Endovascular embolization of A V Ms is a minimally invasive treatment, which has been greatly developed in recent years, especially the introduction of the new embolic agent Onyx gel has provided a powerful weapon for interventionalists. Although embolization has the advantages of being relatively convenient and minimally invasive, only some patients can be completely cured by embolization alone. The complete occlusion rate of AVMs treated with embolization alone ranges from 9.5% to 38% in China and 6.1% to 53.9% in foreign countries. The complication rate of treatment was reported to be 1.5%-25% in China and 3.4%-2 4% in foreign countries. Complications are mainly classified as hemorrhagic and ischemic, mostly related to hemodynamic changes, microcatheter puncture/tear lesions and misembolization of normal blood supply arteries, and vasospasm. Severe bleeding often requires emergency surgery, and relatively rare complications include pulmonary embolism, abscess formation, and acute respiratory distress syndrome. In addition to factors such as operator experience and technical level, the differences in occlusion and complication rates among the groups may be attributable to the different composition of the candidate cases. It is generally believed that lesions that are small in size, have a small number of supplying branches, are superficial on the curtain and compact in configuration are more likely to be completely cured by embolization alone, whereas factors such as multiple supplying branches, fine penetrating branches, deep location, deep drainage and reflux of the supplying artery are thought to be associated with treatment complications. Except for patients with complete embolization of the lesion, most patients who receive single or multiple embolization treatments can have varying degrees of reduction in lesion volume and corresponding symptom improvement. However, incomplete embolization may increase the chance of bleeding from the lesion due to hemodynamic changes, so further microsurgical or radiosurgical treatment is often required. The concept of stereotactic radiosurgery was first proposed by Swedish neurosurgeon Professor L e k s e l l in the 1950s, and is essentially a combination of imaging and computer technology that precisely converges multiple narrow beams of radiation on the lesion for therapeutic purposes. The Gamma Knife is the most commonly used treatment system in stereotactic radiosurgery, and was first successfully applied to the treatment of A V Ms by Professor Stellier in 1970. As of December 2008, 57,136 patients with A V Ms have been treated with the Gamma Knife worldwide (data from Elektra, Sweden). Gamma knife as one of the important means of neurosurgery for the treatment of A V Ms has been proven to be safe and effective by a large number of clinical practices. The advances in imaging technology, radiobiology and more complete treatment systems provide room for the continuous development of radiosurgery. IV. Integrated treatment using a single treatment modality can only make some patients get cured, the combined application of multiple means can make patients get more chances of cure, intravascular embolization treatment can effectively reduce the volume and blood flow of the lesion, which provides convenience for subsequent surgery or radiosurgery, and radiosurgery treatment before surgery can also reduce the risk of surgery and the probability of complications. There is no uniform understanding of the specific protocols for comprehensive treatment. Individualized treatment protocols are needed, taking into account the patient’s age, symptoms, lesion location, vascular configuration, and other factors, as well as the patient’s knowledge of the disease and treatment modalities.