The incidence of spongiform hemangioma is about 0.5%, and symptoms mostly appear at the age of 20 to 30 years, with a comparable incidence in men and women. Clinical presentation: Patients tend to be asymptomatic or present with headache, seizures, neurological deficits, or hemorrhage. The most common clinical symptom is epilepsy compared to other vascular malformations, most of which originate from supratentorial lesions. Older adults tend to present with neurological deficits, compared to 5.6 times more young adults who develop epilepsy. Seizures include partial complex (37%), partial simple (21%), and secondary seizures (43%), with grand mal seizures being most pronounced in frontal lobe lesions. Temporal and frontal lobe lesions are mostly refractory to epilepsy, and almost half (44.7%) of patients with supratentorial cavernous hemangioma present with chronic refractory epilepsy. MRI is the most sensitive and specific imaging method for cavernous hemangioma, and its features include variable central high signal on T2-weighted images, gradual formation of a surrounding meshwork due to hemorrhage at various times, and hypodense areas surrounding the cavernous hemangioma due to iron-containing hemoglobin, with a popcorn or honeycomb shape in the center, which can be significantly enhanced on enhanced scans. The lack of blood supplying arteries and draining veins on MRI images can differentiate cavernous hemangiomas from arteriovenous malformations. CT:Imaging often does not reliably indicate the disease. CT may be the first choice in an emergency when a cavernous hemangioma is bleeding and may show localized hyperintensity or confusion on enhancement. DSA: Imaging of cavernous hemangiomas is mostly characterized by contrast opacification. Treatment The gold standard for treatment is complete surgical resection of the cavernous hemangioma. Indications for surgical treatment may depend on the symptoms presented by the patient, such as seizures, hemorrhage, and focal neurologic deficits. In patients with seizures, the primary issue is to clarify if the epilepsy is difficult to control with medications. Refractory epilepsy is considered as an indication for its surgical treatment, and surgical treatment is advocated for non-intractable epilepsy as well. Hemorrhage is followed by an indication for surgical treatment, and massive symptomatic hemorrhage is an absolute indication for surgical treatment. Patients with cavernous hemangioma without massive bleeding who have focal neurologic deficits may recover to varying degrees over time, and if the dysfunction is progressive, surgical treatment is required. Stereotactic radiosurgery may be considered for small volume lesions, but the rate of bleeding after treatment is high.