Cerebral arteriovenous malformation is a common vascular disease in neurosurgery, and it is also the most complex and difficult to treat cerebrovascular disease at present. It is generally believed that AVM is a congenital abnormality of cerebral vascular development, which lacks normal capillaries between cerebral arteries and veins at the lesion site, and the arteries are connected to the veins through the abnormally developed vascular network, forming a short circuit between cerebral arteries and veins, and producing a series of cerebral hemodynamic disorders, resulting in corresponding clinical symptoms. The main clinical manifestations are cerebral hemorrhage, epilepsy and focal neurological deficits. The average age of diagnosis is 28.3 years, and it has a high mortality and disability rate, so it is of great interest to neurosurgeons, and more studies have been conducted in recent years for its treatment. I. Epidemiology and natural history The incidence of cerebral arteriovenous malformations is about 15 to 18 per 100,000 people, with a total detection rate of about 1 per 100,000 per year, of which more than half of the patients present with hemorrhage, and about 0.55 per 100,000 per year at the time of detection. If a cerebral arteriovenous malformation presents as a hemorrhage, the risk of subsequent hemorrhage is significantly increased. There is also a significantly increased risk of hemorrhage from combined deep venous drainage, associated aneurysms, and profoundly located cerebral arteriovenous malformations. The annual rate of rebleeding is as high as 34% for cerebral arteriovenous malformations that have hemorrhaged, are located deep, and are associated with deep venous drainage, compared to 0.9% for cerebral arteriovenous malformations that have not hemorrhaged, are superficial, and are associated with superficial venous drainage. Overall, the annual rebleeding rate is significantly higher in patients presenting with hemorrhage (4.5%-34%) than in patients without hemorrhage (0.9%-8%), so aggressive surgical treatment is recommended for cerebral arteriovenous malformations presenting with hemorrhage, although evidence from appropriate randomized controlled studies is lacking. Whether to aggressively intervene surgically for cerebral arteriovenous malformations without hemorrhage has consistently been a point of debate in the neurosurgery and interventional neurosurgery community in recent years. Although observational studies in recent years have concluded that treatment-related morbidity and mortality rates have decreased significantly, there is still some risk of death and disability regardless of the treatment approach. This is also a questionable aspect of the ongoing multicenter randomized clinical trial science and trial design for unhemorrhagic cerebral AVMs, such as overly broad inclusion criteria and short follow-up periods, etc. It is still expected that more accurate results can be obtained to guide the clinic in selecting appropriate treatment options for unhemorrhagic cerebral arteriovenous malformations. The choice of treatment options Cerebral arteriovenous malformations have been a thorny problem in neurosurgery for many years due to their complexity and high lethality and disability rates, with poor treatment outcomes. The primary goal of current treatment is to prevent hemorrhage, with secondary goals of seizure control and focal neurological deficits. The main treatment options for cerebral arteriovenous malformations are microsurgical resection, interventional embolization, stereotactic radiation therapy, and a combination of these three modalities. The choice of treatment options depends on the clinical presentation of the arteriovenous malformation and an understanding of the architecture of the arteriovenous malformation, including the staging, location, size, feeding arteries, returning veins, circulation time, and combined abnormal structures (e.g., aneurysms, arteriovenous fistulas). The treatment plan should be individualized to the patient’s clinical condition. With the continuous development and maturation of endovascular treatment technology, interventional embolization is now one of the important measures for the treatment of cerebral arteriovenous malformations at home and abroad. The main objectives are: 1. curative embolization: i.e. complete embolization of the malformation mass so that the malformation mass and the draining veins are no longer visible; 2. target embolization: mainly embolization is performed to reduce the risk of lesion bleeding by targeting bleeding risk factors associated with cerebral arteriovenous malformations such as aneurysms and high-flow arteriovenous fistulas; 3. part of comprehensive treatment: embolization before surgical resection or stereotactic radiotherapy to shrink the volume and reduce the risk of bleeding to facilitate surgery or radiosurgery. The cure rate of cerebral arteriovenous malformation anatomy using interventional embolization alone is low, and it is generally used as part of comprehensive treatment or targeted embolization to reduce the risk of hemorrhage and associated complications. The currently accepted principles of treatment selection are: 1, for small cerebral arteriovenous malformations (less than 3 cm) located superficially in the cortex, microsurgery is preferred; for cerebral arteriovenous malformations with a single arterial blood supply and easily accessible microcatheters, endovascular embolization may also be preferred. 2.Small cerebral arteriovenous malformations (less than 3cm) located in important areas without bleeding, stereotactic radiotherapy is preferred; for non-crossing blood supply type, intravascular embolization is also preferred. 3.For medium-sized cerebral arteriovenous malformation (3-6cm), according to the vascular architecture of the lesion, embolization can be done first to reduce the volume of the lesion for microsurgery or stereotactic radiotherapy. 4.For large cerebral arteriovenous malformation (>6 cm), the risk of various treatment methods is great, so it is feasible to intervene in embolization, target embolization and reduce the volume of malformed vessel groups, and finally occlude the malformed mass or perform radiation or surgery. 5. Interventional embolization is recommended for aneurysms associated with cerebral arteriovenous malformations, and should also be preferred for simple arteriovenous fistulas.