We reviewed 25 consecutive cases of cerebral cavernous malformations that were surgically treated in Okayama University Hospital between 2008 and 2014, and evaluated the surgical approach used for each lesion, its accessibility, navigation, monitoring, and the pre- and post-operative neurological statuses. Of 18 cases involving the supratentorial area, eight of the cavernous malformations were frontal lesions, five were temporal, one was parietal, two were occipital, and two were cavernous sinus lesions. Of seven cases involving the infratentorial area, three of the cavernous malformations were cerebellar lesions, one was midbrain, two were pons lesions, and one was located in the medulla. Microsurgery was performed with the help of intraoperative neuronavigation and neurophysiological monitoring. Most lesions that are to be approached surgically are close to or contact a pial or ependymal surface. Patients with long-term follow-ups (mean: 34.4 months) showed a mean modified Rankin Stroke Scale score of 1.0. Combination of neuronavigation and neurophysiological monitoring contributes to safety of operation and decrease of postoperative disability rate.