Abstract
Brainstem cavernomas represent approximately 15% of all intracranial cavernous malformations. Unlike their supratentorial counterparts, the risk of hemorrhage of brainstem cavernous malformations is approximately 3%, whereas the risk of rehemorrhage has been reported to be greater than 30%. Given their location deep in the brain and proximity to critical structures and fiber tracts, small lesions (particularly when ruptured) may cause significant morbidity. The management of ruptured brainstem cavernomas requires a thorough understanding of the fine balance between their natural history and the intricacies, efficacy, and morbidity associated with their surgical resection. Embolization and radiosurgery do not play a role in management.