Cerebral cavernous malformations (CM) are vascular abnormalities that are composed of abnormal hyalinized capillary groups surrounded by hemosiderin deposits and a gliotic margin. CM is the most common vascular abnormality and account for 10%-25% of all vascular malformations; 70%-80% of them are supratentorial. Magnetic resonance imaging (MRI) in echogradient T2 sequence shows the typical characteristics of the lesion. The annual risk of bleeding is 0.7-1.1% per lesion in patients without a history of bleeding, but increases to 4.5% in patients with previous bleeding. Female sex is related to a worse prognosis. The first description of stereotactic-guided CM resection was published by Davis and Kelly in 1990. Stereotactic procedures, whose main utility is the biopsy of brain lesions, are also indicated in the planning of surgical approaches for small brain lesions, with a precision of 1 mm [12-14]. Brain lesions located near or within eloquent areas represent a challenge for neurosurgeons because of the risks of permanent postoperative neurological deficit, with significant deterioration in the quality of life of the patient. We present the case of a patient with a cavernoma close to the language areas, who did not accept awake surgery and whose lesion was resected using a minimal stereotactic-guided approach. Case Presentation A 36-year-old male patient was admitted to the emergency of our institute with a 2-year history of tonic-clonic epileptic seizures with transient postictal motor aphasia, fully controlled with levetiracetam (500 mg/12 h), and an episode of status epilepticus secondary to bleeding from the CM. Neurological and neuropsychological examination found moderate neurocognitive deterioration (alterations in attention, concentration, reading comprehension and auditory verbal and working memory) without motor or sensory deficits and preserved language. Echogradient T2 MRI images demonstrated a left paraopecular lesion with typical characteristics of CM (lobulated lesion surrounded by a hypointense halo). Functional MRI demonstrated the expression language areas (Broca) towards the anterior border of the lesion and the comprehension language area (Wernicke) towards the posterior part. A medial displacement of the arcuate tract was seen in the tractography of frontotemporal association pathways.