The clinical manifestations of spinal cord cavernous hemangioma can be as follows: (1) intermittent and recurrent neurological dysfunction due to recurrent microhemorrhage or thrombosis in the malformed vessels, with varying degrees of recovery of neurological function between episodes. This is one of the main features of cavernous hemangioma. (2) Progressive increase in the size of cavernous hemangioma due to thickening of the interstitial space caused by hemorrhage, and chronic progressive neurological decompensation. (3) Intramedullary hematoma caused by hemorrhage results in rapid progression of the patient’s disease and rapid decline in neurological function, which can lead to serious consequences such as paraplegia. (4) Asymptomatic, incidental discovery. (1) Asymptomatic patients with incidental findings on MRI should be treated conservatively and observed closely; (2) patients with progressive neurological impairment should be treated surgically; (3) patients with transient seizures mostly need surgery, while some can be treated with conservative observation. For some cases with mild symptoms and small lesions located deep in the spinal cord, it is prudent to consider whether surgery should be performed. The MRI can be reviewed regularly and surgery should be performed as soon as the lesion is found to increase in size or if the neurological symptoms worsen. Generally speaking, if the lesion is removed before the spinal cord is severely damaged, good treatment results can be obtained; if the spinal cord is severely damaged, even if the lesion is removed, it is difficult to restore the function of the spinal cord. The red dotted line shows the spinal cord cavernous hemangioma surgery precautions: The abnormal blue-purple or purple-brown area with clear borders is usually seen on the surface of the spinal cord. If no hemangioma is seen on the surface of the spinal cord, the spinal cord is incised in the posterior median sulcus, and the hemangioma is seen in the shape of a mulberry or a lobulated shape with a border with the normal spinal cord. After checking the tumor bed for residual hemangioma, the soft spinal membrane is sutured to close the tumor bed, and the incision is closed in layers. Weak bipolar electrocoagulation is used to stop the hemorrhage, and the duration of each electrocoagulation should be short, and saline should be used at all times to prevent the spinal cord from being damaged by the diffusion of heat generated during electrocoagulation. The shape of the lesion is often irregular or lobulated, and care should be taken not to leave the lesion behind. In case of uncontrollable bleeding, the tumor should be further investigated for residual tumor, as it may recur if part of the lesion remains. If the boundary between the hemangioma and the spinal cord is unclear, it should not be removed blindly to avoid damaging the normal spinal cord. If the hemangioma grows diffusely and there is no obvious demarcation with the spinal cord, only partial resection should be performed to protect the function of the spinal cord, and the residual tumor should be repeatedly cauterized by electrocoagulation to induce wrinkling of the tumor. Our experience is that the repeated bleeding of cavernous hemangioma causes reactive gliosis in the surrounding tissues, so that a circular glial layer, similar to a pseudomembrane, is formed between the hemangioma and normal spinal cord tissue. Under the microscope, the hemangioma is carefully separated from the normal spinal cord along this pseudomembrane to avoid damage to the spinal cord. Since spinal cord cavernous hemangioma is a low-pressure vascular malformation, it can be easily and completely removed, and the surgical complications are low. Small, incompletely developed drainage veins can sometimes be seen around the lesion during surgery and need to be carefully removed. It should be emphasized that the soft spinal membrane needs to be sutured after hemangioma removal to avoid gliosis and to maintain the integrity of the spinal cord. If the boundary between the hemangioma and the spinal cord is unclear, the hemangioma should not be removed blindly to avoid damage to the normal spinal cord.