Cerebral cavernous hemangiomas (CCMs) have a prevalence of 0.1-0.5% and account for approximately 5-10% of patients with central vascular malformations. CCMs cause epilepsy in 5.6% of patients with epilepsy, and their clinical features are relatively clear, but the ideal treatment is still vague, including the timing of surgery and the extent of surgical resection. In this paper, we present a comprehensive analysis of the pathological findings, clinical manifestations, and epileptogenic mechanisms of CCMs and propose principles of individualized surgical treatment supported by the study results. Pathological findings: CCMs are congenital vascular lesions that can occur in any part of brain tissue, but mainly in the curtain. cCMs are composed of endothelial cells arranged to form lumens, which are closely packed by dilated vascular lumens in a spongy structure, but lack mature vascular structures with no brain tissue between them. EVG staining shows that they are vascular walls, including endothelial cells and connective tissue outer membranes, and elastic tissue and muscle layers are absent It is often accompanied by fibrosis, thrombosis, calcification, and even ossification, and is surrounded by haematoxylin-filled foamy macrophages. Clinical manifestations: 40-70% of episodic CCMs have epilepsy as their first symptom, of which 35-40% develop drug-refractory epilepsy; some patients with CCMs also present with hemorrhage or other neurological symptoms. Mechanism of epileptogenicity: CCMs are not epileptogenic per se; their epileptogenicity lies in the surrounding brain tissues and distant brain tissues. Many studies have confirmed that the brain tissue around CCMs is hyperexcitable. Whether in the cortex or hippocampus, spontaneous high-voltage synaptic events are significantly increased compared with the brain tissue around the tumor, and the nerve cells around CCMs show enhanced excitatory responses to synaptic stimuli; the incidence of spike waves in the brain tissue around CCMs is high. As CCMs are prone to vascular rupture, CCMs can hemorrhage repeatedly. Repeated hemorrhage causes glial reaction and hemochromatosis in the surrounding brain tissue, and local ischemia, venous hypertension, gliosis and inflammatory reaction can cause epilepsy, and histologically the brain tissue around CCMs loses its normal structure. Therefore, the surrounding tissues are epileptogenic. 2. Epileptogenicity of distant brain tissues: As patients have recurrent seizures, they can cause synaptic changes in the hippocampus and other midline structures with synchronous reactions, forming secondary epileptic foci. Therefore, in patients who have formed secondary epileptic foci, seizures will still occur even if the CCMs and their surrounding tissues are removed. Treatment of CCMs 1. Pharmacological treatment of CCMS: Only 4% of patients with incidentally detected CCMs develop epilepsy within 5 years; therefore, prophylactic antiepileptic drug (AED) therapy is not required for this patient; for CCMs with complicating symptoms of hemorrhage, only 6% of patients develop epilepsy within 5 years, so prophylactic AED therapy is also not required; for patients with CCMs with epilepsy, AED can keep 71-73% of patients from developing epilepsy, and its treatment effect is similar to that of surgical treatment. Therefore, some suggest surgical treatment only as a treatment to control epilepsy in patients with refractory epileptic CCMS. 2. Surgical treatment of CCMS: Surgical treatment modalities include focal resection, i.e., CCMs combined with local excision of different ranges of epileptogenic foci, and lobectomy including CCMs. Focal resection is mainly used in patients with uncomplicated epilepsy caused by CCMS, and the resection area should include at least the cortical layer containing iron to flavin deposits, while lobectomy is mainly used in patients with two to epileptic foci of complicated epilepsy, such as those with hippocampal sclerosis, and the resection area includes the lobes and hippocampus, similar to the surgical resection of temporal lobe epilepsy. 3. Results of surgical treatment: 65-75% of patients were seizure-free after surgery, and 60% of patients with foci resection were seizure-free after surgery. In a group of patients with CCMs, extratemporal lobe CCMs were all seizure-free after surgery, while 87% of patients with temporal lobe CCMs were seizure-free after temporal lobe resection, while another group of surgical treatment studies showed that 78% were seizure-free within one year, 67% within 5 years, and 59% within 10 years. The shorter the time of epileptogenesis, the better the surgical outcome; 2. The extent of resection, lobectomy is better than focal resection, even in patients with CCMs not showing multiple epileptogenic foci, resection of hippocampus is better; 3. The location of CCMs, the clinical treatment results of Cleveland Medical Center showed that the incidence of seizure-free postoperative CCMs in different locations: 0 % , frontal lobe 83%, insula 75%, and temporal lobe only 57%, because of the strong electrophysiological anatomical and functional connection between parietal and temporal cortex and hippocampus, which can easily stimulate the formation of secondary epileptic foci. For CCMs with a short history of seizures and no abnormalities in the hippocampus and other midline structures, only focal resection is performed, and for those with a long history of seizures (>1 year) and hippocampal damage, combined temporal lobes and hippocampal resection is performed. 3. For those with a long history of epilepsy and normal hippocampal structure, temporal lobectomy can be performed, preserving the hippocampus, especially in the dominant cerebral hemisphere, to reduce the cognitive impairment caused by surgery, but it also varies from person to person. Conclusion: CCMs are the causative factor of epilepsy, and epilepsy can be caused by damage to brain tissue around CCMs or by formation of secondary epileptic foci away from CCMs through anatomically-functionally connected nerve fibers, Anti-epileptic drug therapy can be the first-line treatment option, and if epileptic drugs are tolerated, surgery other than CCMs and peripheral cortical resection, early surgery and epileptogenic foci associated with epilepsy Early surgery and complete resection of epileptogenic foci associated with epilepsy are key to surgical outcome, and treatment of patients with temporal lobe CCMs without hippocampal damage still needs further exploration.