Background: This report describes our preliminary experience of treating intracranial cavernous malformations (CMs)by employing a frameless, image-guided, robotic radiosurgical apparatus – CyberKnife stereotactic radiosurgery (CKS).Methods: From 2007 to 2010, 20 patients (11 male and 9 female; age range: 25-71 years) with 25 intracranial cavernous malformations who accepted CyberKnife stereotactic radiosurgery (CKS) were retrospectively evaluated by annual hemorrhage rate, seizure control and adverse radiation effect. Target lesions were delineated by pre-CKS MR imaging and the optimal isodose line was selected according to maximizing the percentage of lesion coverage and minimizing nearby
normal structure involvement. We contoured nearby critical structure with dose limits settings and prescribed delivery doses to the target lesions. The optimal treatment plan was determined by the inverse treatment planning function system.Results: The mean follow-up period was 22.35 months (range: 8-36 months). No adverse effects of CKS were observed
in the course of treatment. Posttreatment hemorrhage was found in one patient (5 months after CKS). The annual hemorrhage rate within the two year latency interval after CKS was 3.03%. The annual hemorrhage rate was uncertain beyond the two year latency interval. Conclusions: CyberKnife stereotactic radiosurgery provides an optimal treatment strategy for managing intracranial CMs in surgically high-risk patients. It is effective in reducing annual hemorrhage rates and protecting seizure attacks while minimizing adverse radiation effects within a limited follow-up time interval.