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Cavernous Malformations are low flow vascular lesions characterized by dilated vascular capillary channels with no intervening neural tissue. They can occur in the brain and spinal cord. The blood vessels forming these cavernomas are abnormal and leaky and hence tend to hemorrhage. They can present with seizures, headaches, and neurologic deficits depending on where they are located. Three genes namely CCM 1,2 and 3 participating in endothelial cell signaling are implicated in their formation. Cavernous Malformations are safely and effectively treated with surgery if they hemorrhage and are symptomatic. A thoughtful approach to cavernoma resection is necessary for lesions in eloquent locations such as the brainstem. Only hemorrhagic lesions that present to the pial or ventricular surface and within safe corridors should be operated on. Operative Navigation and neurophysiologic monitoring are important operative adjuncts. Radio surgery for cavernous malformation is controversial and has not proven to be beneficial across all studies.