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A 43-year-old, right handed female presented with loss of consciousness due to an intraparenchymal and intraventricular hemorrhage from a ruptured grade 5 AVM (arteriovenous malformation). The AVM was embolized in 3 stages and resected with good clinical and angiographic outcome at 15 years after surgery. No other similar long-term reports could be found in the literature. We discuss the rationale to operate, the crucial role of preoperative embolization, as well as the short- and long-term postoperative management.