Intracranial arterio-venous malformations (AVM) are relatively uncommon, but increasingly recognized lesions that can cause serious neurological symptoms or death. Although AVM can initially present with hemorrhages or seizures, an increasing number is detected before symptomatic bleeding due to the recently developed imaging techniques. Over the last decades, the management of AVM has been widely modified due to the availability of neuronavigation and minimally invasive endoscopic surgery techniques, endovascular embolization and radiosurgery. As the management options have evolved, individual and combined modality treatment protocols have been developed in different institutions for the management of AVM. Besides preservation or improvement of neurological function, the main requirement for AVM treatment is the risk of bleeding. The main goal in AVM treatment is, therefore, the complete elimination of the nidus to cure the patient. Currently, it is well established that the entire nidus has to be removed or inactivated, respectively. Neither feeding arteries nor draining veins should be pursued beyond their points of attachment to the nidus to avoid unnecessary normal tissue damage [25]. Detailed information concerning the size, localization of the nidus, arterial feeders and venous drains is required for treatment planning as well as proof of lesions due to bleeding or atrophy or gliosis in the surrounding brain.