Abstract】Objective To investigate the role of electrocorticogram (ECoG) monitoring in temporal lobe cavernous hemangioma surgery with epilepsy. Methods The clinical data and surgical methods of 74 cases of temporal lobe cavernous hemangioma with epilepsy were retrospectively analyzed. The cases were grouped according to the presence or absence of intraoperative cortical electroencephalogram (EcoG) monitoring, with 41 cases with EcoG monitoring and 33 cases without EcoG monitoring. The study group underwent enlarged lesion resection, amygdala hippocampal resection and even anterior temporal lobectomy under EcoG monitoring, while the control group only performed simple lesion plus peripheral heme-containing band resection, and the follow-up results were analyzed for efficacy. The overall postoperative seizure control rate was 54 cases (72.9%) in Engle grade I, 12 cases (16.2%) in Engle grade II, 3 cases (6.8%) in Engle grade III, and 2 cases (4.1%) in Engle grade IV. The short history (84.2. %) was better than the long history (69.1%), and the rate of epilepsy control with surgical resection under ECoG monitoring (87.8%) was better than without ECoG monitoring (54.5%). Conclusions The timing and outcome of surgery in patients with temporal lobe cavernous hemangioma with epilepsy are related, and surgery should be performed as early as possible. Enlarged resection of the lesion or lobectomy under ECoG monitoring will result in a better rate of epilepsy control. Shan Yongzhi, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University