Three special cases of AVM finally treated with conventional microsurgical method are presented. Two cases of medium sized AVMs were located at the central region, one of them was primarily treated with Gamma-knife followed by endovascular embolization having been complicated with growing cyst formation followed ultimately by microsurgical removal. The AVM of another case was embolized three times, followed by removal of the residual nidus under awake surgery. The third AVM located at the hypothalamus in the vicinity of the optic nerve was considered unsuitable for embolization and Gamma-knife therapy, and therefore removed by microsurgery using special approaches after a trial of embolization. In terms of microsurgical removal, preoperative embolization, embolization material, awake surgery and selection of special approaches are discussed.