Since sylvian arteriovenous malformations’ (AVMs) arterial feeders are supplied from middle cerebral artery (MCA) branches and their nidus is located adjacent to functional structures, they are challenging lesions to remove surgically. We review the different characteristics of AVMs such as size, flow, feeders, venous drainage, eloquence and therapeutic strategies. With low postoperative morbidity, almost patients achieved favorable outcomes. The author recommend that microsurgery should be selected as the primary treatment for sylvian AVMs. Removal of nidus completely without new neurological impairment is very important in the treatment for sylvian fissure AVMs.

A total of 57 patients with basilar apex aneurysms were treated at our hospital from January 1990 to May 2011. The 57 patients were comprised of 18 male and 39 female patients aged from 31 to 81 years old (Mean age: 58.4 years old). Twenty nine cases were treated surgically and 28 cases underwent endovascular coiling. Medical and surgical records, postoperative angiographies, and follow up angiographies were reviewed retrospectively. Basilar apex aneurysm remains the ultimate challenge to neurovascular surgeons. Mortality and morbidity of endovascular coiling cases was relatively lower than that of surgical cases.