I recently admitted a patient with an intracerebral arteriovenous malformation and was overwhelmed with emotion! Let’s start with the patient’s treatment process. The patient is a 15-year-old male, diagnosed with arteriovenous malformation in the left basal ganglia region in 2006, and was treated with X-knife in a hospital, and the malformed vascular mass was slightly reduced in the follow-up examination in 2008. Since then there was no reexamination. CT+enhancement in ’06 and review in ’08: For some patients with intracranial arteriovenous malformations, X-knife or Gamma Knife can be used to obtain curative results. However, this patient was not so lucky. Sudden hemorrhage a few days before. Pictures of intracranial hematoma: The patient had sudden confusion with convulsions, and an urgent CT suggested: intracerebral hematoma in the left basal ganglia region. When the patient arrived at our department, he was breathing shallowly and rapidly, and was in a coma, with a 6mm pupil on the left side and a 4mm pupil on the right side, and bilateral light reflexes were absent. The patient’s condition was critical, and the treatment group discussed the following: 1. Conservative treatment, complete imaging examination, embolization of part of the blood-supplying arteries, and then hematoma removal + malformation vascular excision. 2. In view of the patient’s large intracranial hematoma, the brainstem has been significantly compressed, conservative treatment of the patient may rapidly aggravate the symptoms.2. Emergency surgical treatment. The patient’s arteries and draining veins of the malformed vessels were located in deep places, and uncontrollable hemorrhage might occur during the operation. After communicating with the family, the family chose surgical treatment. Most of the malformed vessels were removed + hematoma was removed. Postoperative follow-up CT: 1, most of the malformed vessels have been removed, 2, the hemorrhage in the basal ganglia area has been clarified, and 3, the hemorrhage flowed into the ventricles during the operation, resulting in ventricular hemorrhage$ After the operation, the patient’s pupils were symmetrical on both sides, with a diameter of 2.5 mm, and the light reflex was hourly. Mental stupor, recurrent fever, tingling visible left limb movements. Now the patient is on the third postoperative day, and the risk of postoperative rebleeding has been greatly reduced, however, the patient is now experiencing severe cerebral edema. We have resuscitated the patient back after all efforts and hopefully he will wake up. I am keeping my fingers crossed!