Cavernous malformation affecting the central nervous system represents approximately 5–10% of the central nervous system vascular malformations. Most commonly, cavernomas are found at the supratentorial region (75%) and rarely in the brainstem, accounting for approximately 20% of all intracerebral cavernous malformations. They are occasionally encountered in the anterior basal ganglia, where their proximity to the caudate nucleus, putamen, globus pallidus, internal capsule, and anterior thalamus makes them sensitive to lesional hemorrhages. Hemorrhage-related deficits can include movement disorders, imbalance, contralateral hemiparesis, contralateral hemisensory loss, and hemianopsia. This region is difficult to approach surgically, with options that include through the transfrontal, the transcallosal transventricular, the pterional transsylvian, and the pterional transinsular routes or through a combination of any of these approaches.