New surgical techniques have extended the indication for operative treatment of angiomas located in the midline structures and in regions of vital and functional importance. The absolute contraindications to treatment of huge cerebral angiomas have also diminished. However, experience is still limited, and there is no uniform approach. Judgement of the natural risk to which an angioma exposes the patient as well as the evaluation of the operative risk and the possible consequent neurological deficits is based on multiple, not clearly defined factors among which the subjective opinion and experience of the individual surgeon play an important role. In patients with space occupying lesions the indications and contraindications for surgery are far more clear-cut and objective, whereas in centrally located angiomas it is seldom possible to be definite unless, maybe, a hematoma causing raised intracranial pressure is found.