Epilepsy is a common clinical manifestation of supratentorial cavernous hemangioma, often with intractable recurrent seizures, of which about 40% are refractory. In the past, surgery was only performed for those who were difficult to control with medications. With the development of intraoperative evaluation techniques and neurosurgical techniques, the indications for surgery have been gradually relaxed. Most spongiform hemangiomas are located on the curtain, and epilepsy is the most common reason for patient visits, at 40% to 70%. The diagnosis of cavernous hemangioma relies on CT and MRI, especially the combination of the two is helpful to improve the preoperative diagnosis, CT is not very specific for the diagnosis of cavernous hemangioma, but it has an important role in the differential diagnosis, showing round-like high-density shadow in the brain, and some lesions may have scattered dotted calcifications. The typical MRI image of cavernous hemangioma is a round or round-like mixed signal surrounded by a ring of low signal (iron-containing heme deposits), the so-called “black ring sign”, which is a prominent feature of cavernous hemangioma; it is not enhanced or mildly enhanced by contrast injection. The epilepsy caused by cavernous hemangioma may be related to the repeated bleeding and enlargement of the lesion, and the presence of iron ions in the blood in the form of Fe2+ in ferric heme, which is gradually squeezed to the edge of the lesion during the repeated bleeding process, forming a band of ferric heme deposits, which can lead to epilepsy that is difficult to control with drugs. Treatment of cavernous hemangiomas that present clinically as epilepsy only is controversial. Although direct functional damage can be avoided by gamma knife treatment of cavernous hemangiomas, the lesions still have the potential for rebleeding and cerebral edema, and epilepsy does not completely disappear, so it is not the best treatment. In the past, it was believed that patients presenting solely with epileptic symptoms, with little risk of potential hemorrhage, did not require surgical treatment when epilepsy was well controlled by medication. Because only some patients are sensitive to antiepileptic drugs and have an annual spontaneous hemorrhage rate of up to 0.7%, most scholars now believe that cavernous hemangiomas with epilepsy should be actively considered for surgical treatment. Stefan suggests that surgical treatment should not only remove the lesion but also remove all the epileptogenic tissue surrounding the lesion as detected by ECoG. Microsurgery with total excision of the lesion and removal of as much of the surrounding yellow-stained tissue as possible, using preoperative EEG assessment and intraoperative ECoG monitoring techniques to determine the location and extent of the epileptogenic lesion, provides more precise guidance on the extent of excision and facilitates excision of the epileptogenic lesion and reduces damage. For small lesions and deeper sites, microsurgery is best performed with the assistance of stereotactic or neuronavigation. Therefore, microsurgical treatment of supratentorial cavernous hemangiomas with only epileptic manifestations is effective. Intraoperative application of ECoG monitoring and neuronavigation techniques can both avoid excessive brain tissue damage and significantly improve postoperative epilepsy control rate.