Cerebral cavernous hemangioma is a type of congenital cerebrovascular malformation. It is generally believed that the central nervous system symptoms are mainly manifested by seizures, intracranial hemorrhage and local neurological dysfunction. With increasing understanding, the relationship between epilepsy and cavernous hemangioma has been increasingly emphasized. It has been estimated that about 4% of seizures in patients with localized epileptic seizures as the main symptom are due to cavernous hemangioma. However, the choice between drug control alone or surgical treatment of epilepsy associated with cavernous hemangioma is controversial. About 3/4 of the episodes are located in the supratentorial area, mostly in the subcortical area, but there are cases where the lesions are in the basal ganglia and pons. The clinical manifestations of spongiform hemangioma include epilepsy, hemorrhage, and neurological dysfunction. The clinical manifestations of this disease are closely related to the location of the lesion. Seizures and hemorrhage are common in supratentorial lesions, while infratentorial lesions are often characterized by local neurological dysfunction, and seizures are rare. The literature reports that the incidence of epilepsy ranges from 34% to 70%. Seizures tend to be limited and generalized. The mechanism of epilepsy due to cavernous hemangioma is generally considered to be related to local electrophysiological changes in the lesion, alterations in neurotransmitters (increased excitatory amino acids), iron-containing heme deposits and gliosis. For the treatment of cavernous hemangioma with epilepsy as the first symptom, there are two views: one is that patients presenting solely with epileptic symptoms have little risk of potential bleeding and do not require surgical treatment if the epilepsy is well controlled by drugs, unless there is poor efficacy of drugs for epilepsy control or combined bleeding or rebleeding and progressive growth on MRI to consider surgery.