Giant cerebral cavernous malformations (GCM) are rare vascular anomalies. They occur predominantly as solitary lesions in the supratentorial compartment. They are usually not associated with any other vascular malformations. Clinical Presentation GCM are common in the second decade, affecting females predominantly, and occur without familial association. They are all symptomatic due to their giant size and location. The GCM mimic neoplastic lesions because of their size and need to be considered in the differential diagnosis. A complete surgical extirpation is the treatment of choice. Use of intraoperative neuronavigation, diffusion tensor imaging (DTI) of fiber tracts and electrophysiological monitoring assist in safe and total excision of the lesions. A complete surgical excision of GCM is possible without significant surgical morbidity and results in long term cure.