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Surgical treatment of the cerebral arteriovenous malformations (AVMs) is one of the most difficult neurosurgical practices, because neurosurgeons may not get adequate practice operating on patients with AVMs and because the variation of the characteristics of these lesions makes it difficult to establish a standard technique and skill to effectively resect these complicated vascular tangles in the brain parenchyma. However, it is mandatory for any vascular neurosurgeon to manage patients with AVM who present with severe neurological deficits or moribund condition due to hemorrhage. Here we report on our experiences of AVM cases and suggest that it is possible to remove the AVMs safely if the surgeon can open the cerebral sulci widely without trauma and without any nidal venous compromise using basic arachnoid dissection technique. We present illustrated cases and discuss the importance of the dissection of the cerebral sulci and staged surgery for large AVMs.
