Durability of excellent outcome for 15 years after resection of a ruptured grade 5 arteriovenous malformation

•The decision was made to operate on a ruptured, grade 5 arteriovenous malformation (AVM).•Staged embolization was crucial in allowing a subsequent surgical resection.•After 3 stages of embolization, the AVM was resected with good clinical and angiographic outcome, presently, 15 years after surgery. 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.