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Cavernous malformations are cerebrovascular anomalies that may be observed throughout the central nervous system, mainly in the supratentorial location, comprising about 10% of all cerebrovascular lesions. They frequently affect young patients, and may be observed as sporadic form or familial (hereditary) form. They may appear as single or multiple lesions. Most patients who present with the multiple lesions are likely to harbor the hereditary form of the disease. Magnetic resonance imaging is the standard imaging to diagnose the cavernous malformation, as they are angiographically occult. An autosomal-dominant pattern of inheritance with variable penetrance is responsible to the familial form of the disease. There are 4 types of clinical presentation of the cavernous malformation: seizures, headaches, neurologic deficits, and asymptomatic presentation. The treatment consists of microscopic surgical resection assisted by intraoperative neuronavigation, stereotaxy, or ultrasound, with minimal morbidity. Radiosurgery may be considered for patient with multiple hemorrhages from a surgically inaccessible lesion, or in clinically ill patients without health for surgery. We report a series of 29 patients harboring supratentorial cavernous malformations surgically removed, operated from 1999 to 2009, at São Paulo, Brazil, by the same surgical crew, to verify surgery as the primary management strategy. [ABSTRACT FROM AUTHOR]