This study investigates the safety and outcomes of surgical resection of cerebral cavernous malformations (CMs), focusing on clinical presentation, radiological features, and anatomical locations. The research included patients operated on from January 2008 to January 2018 for supratentorial and cerebellar cavernomas, categorizing supratentorial CMs into non-critical, superficial critical, and deep critical subgroups. The clinical outcomes were evaluated using the modified Rankin Scale (mRS), with favorable outcomes defined as mRS 0-1. Post-operative epilepsy control was assessed via the Maraire Scale.

Out of 144 eligible patients, those with cerebellar or lobar CMs in non-critical areas showed excellent outcomes (91.1% with mRS ≤ 1), as did patients with superficial CMs in critical areas (92.3% with mRS ≤ 1). However, patients with deep-seated supratentorial CMs had a lower rate of favorable outcomes (76.9%). Regarding epilepsy, 58.5% of patients with a history of epilepsy were seizure-free without therapy at the last follow-up (mean 3.9 years), and an additional 41.5% had complete seizure control with therapy.

Significance: This study highlights that surgical resection of CMs is generally safe, including in critical supratentorial locations, though caution is advised for deep structures like the insula, basal ganglia, and thalamus/hypothalamus. It provides valuable insights into the factors associated with favorable surgical outcomes, contributing to the optimization of treatment strategies for patients with CMs.