[Object] Intramedullary spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to surgical resection with or without adjuvant embolization.We retrospectively reviewed the senior author ' s (RFS) contemporary surgical series of intramedullary spinal AVMs to evaluate clinical and radiographic outcomes.[Methods] Detailed chart and radiographic reviews were performed for all patients who underwent surgical treatment of intramedullary spinal AVMs from 1994 to 2011.Presenting and follow-up neurological examinations were obtained and graded using the modified Rankin (mRS) and McCormick Scales.Surgical technique, outcomes, complications, and long-term angiographic studies were reviewed.[Results] During the study period, 20 patients (10 males) underwent surgical resection of an intramedullary spinal AVM.The mean age at presentation was 30 ± 17 years (range 7-62 years).AVM location was as follows: cervical (n=10), thoracic (n=9), and cervicothoracic junction (n=1).The most common presenting signs and symptoms included paresis or plegia (65%), paresethesias (40%), and myelopathy (40%).Perioperative embolization was performed in the majority of patients (60%).A pial resection technique was used in 18 cases (90%).Angiographically verified AVM obliteration was achieved in 15 patients (75%).At a mean follow-up of 45.4 ± 52.4 months (range 2-176 months), 14 patients (70%) remained functionally independent (mRS and McCormick scores ≤ 2).One perioperative complication occurred, yielding a surgical morbidity rate of 5%.Three symptomatic spinal cord tetherings occurred at a mean of 5.7 years after AVM resection.No neurological declines were observed after endovascular and surgical interventions.No deaths occurred in the series.Long-term angiographic follow-up was available for 9 patients (40%) at a mean of 67.6 ± 60.3 months (range 5-176 months) after AVM resection.Durable AVM obliteration was observed in 5 of 6 patients (83%).[Conclusions] Intramedullary AVMs may be safely resected with satisfactory clinical and angiographic results.The pial resection technique effectively devascularizes these lesions without violating spinal cord parenchyma, potentially reducing iatrogenic injury.