Objective: The purpose of this report is to review intracranial arteriovenous malformations, present strategies for the evaluation and selection of optimal treatment modalities, and to discuss factors important to formulating a successful treatment plan. Methods: The authors performed a critical literature review in order to highlight recent and classic studies about intracranial arteriovenous malformations. Results: Recent advances in diagnostic techniques, microsurgery, endovascular therapy, and stereotactic radiosurgery have significantly improved the treatment outcome of vascularmalformations of the central nervous system. In patients who are minimally symptomatic, in normal neurologic condition, or whose treatment risk is high, not recommending any treatment can be an excellent viable option. For the others, microsurgery, endovascular embolization, and stereotacticradiosurgery offer complementary advantages and improve the chances of a lifetime cure. Conclusion: A thorough knowledge of the natural history ofintracranial arteriovenous malformations is fundamental to the treatment decision making process. A multidisciplinary team approach with the neurosurgeon taking a leading role is as well essential for a successful intracranial arteriovenous malformation management.