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.