A cavernous malformation is a benign mulberry-shaped vascular malformation formed by abnormal development of the vascular bed during the embryonic period, consisting of irregular, thick and thin sinusoidal lumens that may be hemorrhagic, calcified or thrombosed. Spongiform vascular malformations have been reported to account for 5% of all vascular malformations in the central nervous system, mostly in the brain, followed by the cerebellum and brainstem (1/5 of cases), and rarely in the spinal cord. Seizures, hemorrhage and neurological deficits are common clinical signs, and some patients are found accidentally. For asymptomatic patients, conservative treatment with regular MRI or CT follow-up is often used; for symptomatic patients, surgical resection is the radical treatment for this disease. Surgery is based on the patient’s specific situation, such as the depth of the lesion, whether it is located in an important functional area, and the possible postoperative risks to the patient, and the decision can only be made with the informed consent of the patient or family. With the application of microsurgical techniques and precise technologies such as neurophysiological monitoring and neuronavigation, cavernous vascular malformations including the brainstem, such as the present case, can also be safely resected, resulting in good outcomes.