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We introduce an uncommon case of small arterio-venous malformation (AVM) on a critical location. A young woman with left anterior medial temporal AVM was referred to our department in comatose state. We decided to treat this case by open surgery. Secondary hydrocephalus occurred and a ventriculo-peritoneal shunt was inserted. The postoperative course was with no complications, and the patient was discharged in good state and six months later she resumed her activity. The case is of interest in the light of the decision-making process, and the techniques and surgical skills for the surgery of arterio-venous malformations on this critical location.