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Background: Cerebral cavernous malformations (CCMs), particularly when located in the cerebellum, pose unique clinical challenges due to the risk of hemorrhage and proximity to critical neurovascular structures. Surgical resection is often necessary to prevent further neurological deterioration. This case report describes the management of a symptomatic cerebellar cavernoma, emphasizing the use of microsurgical techniques and long-term follow-up. The objective of this study is to illustrate the surgical approach and outcomes of a patient with a hemorrhagic cerebellar cavernoma. Methods: A 63-year-old female presented with vertigo, and neuroimaging revealed a hemorrhagic cavernous malformation located in the right cerebellar hemisphere. Follow-up was conducted at two months and one year postoperatively, with serial imaging to assess lesion recurrence and neurological recovery. Results: Complete resection of the cavernoma was achieved without postoperative neurological deficits. Imaging at two months and one year post-surgery showed no signs of recurrence or new lesion formation. The patient remained asymptomatic, with no cranial nerve deficits or other long-term complications. Conclusions: This case demonstrates the effectiveness of microsurgical resection in treating symptomatic cerebellar cavernomas. The use of advanced intraoperative tools, such as neuronavigation and IONM, contributed to the successful outcome and prevention of postoperative complications. Long-term follow-up remains crucial to monitor for recurrence or the development of de novo lesions. Full article