Brainstem cavernous malformations have a high risk of hemorrhage, ranging from 4 to 60%, this risk being even higher in children where larger lesions are encountered. Even small hemorrhages can cause ,severe neurological symptoms because of the high density of cranial nerve nuclei and fiber tracts within the brainstem. The goal of surgical treatment is not only the improvement of neurological symptoms, but also preservation of the patient’s quality of life. We present a case of a 10 years old female pacient who presented after a 5 weeks conservative treatment with right sided weakness and loss of coordination, right hemihipoesthesia, She was diagnosed with a large left pontine cavernous malformation on MRI. The cavernoma was resected using a retrosigmoidian approach , but a small remnant was left, when the surgery had to be stopped due to severe bradicardia. The neurological deficit improved at follow up.The choice of the surgical approach that allows the best exposure of the lesion is mandatory. In this case the lesion was evident on the surface of the brainstem and this facilitated its resection. Traction on the tumor and coagulation near the cranial nerves nuclei should be avoided, but if bradicardia appears the surgery must be stopped.Surgery is the best choice for the patients with symptomatic brainstem cavernomas that present with hemorrhage and neurological deficit, and its objectives should be complete removal and improvement of neurological deficit. 
