Small lower-grade Spetzler-Martin arteriovenous malformations (AVMs) are mainly treated by microsurgical resection or stereotactic radiosurgery. The choice of treatment largely depends on the referring centre's preference and the patient's decision.
We present here a patient with an AVM repeatedly treated at our Leksell Gamma Knife unit with radiographically confirmed obliteration of the AVM which subsequently began bleeding. The risk of haemorrhagic complications of radiosurgically removed AVMs despite angiographic proof of their obliteration is, in our view, a cogent argument for preferring surgical resection if the AVM.