BACKGROUND: Vascular malformations (VMs) are a collection of rare diseases that result from abnormal overgrowth of vascular tissue and can lead to pain, infection, disfigurement, and decreased mobility. Vascular malformations can invade or impinge on nearby structures, including nerves, causing pain, numbness, and/or functional impairment. If nonsurgical therapy fails, surgical resection is considered. However, VMs' thin walls and tendency to infiltrate and/or recur makes resection difficult or impossible. Rather than resecting, we have found that patients can still benefit from surgery in the form of nerve decompression. Here, we present a series of patients with VMs causing symptomatic nerve compression that were successfully treated with nerve decompression, with or without VM resection. It is the purpose of this study to demonstrate that VM patients with nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is considered "resectable." METHODS: Retrospective chart review of patient undergoing nerve decompression surgery for symptoms of peripheral nerve compression (pain and/or motor/sensory dysfunction) attributable to a nearby VM (confirmed on preoperative magnetic resonance imaging), with or without VM resection. RESULTS: Six patients with peripheral nerve compression attributable to VM were treated with nerve decompression. One also underwent VM resection. Five of the 6 patients had undergone previous surgical intervention (resection or sclerotherapy) without clinical improvement in radiculopathy. Following intervention, all patients demonstrated improvement of their pain and motor/sensory dysfunction. CONCLUSIONS: Patients with VM nerve pain and/or sensorimotor dysfunction should be referred for evaluation by a peripheral nerve surgeon, regardless of whether the VM is deemed resectable. Even when unresectable, patients may still benefit from surgery in the form of nerve decompression.