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Seizures are among the typical presentations of intracranial cavernous angiomas (ICA). Twenty-one patients (age range: 2 to 53 years) treated for seizures associated with ICA between 1983 and 1997 were restrospectively studied to evaluate their outcome following medical or surgical intervention. The mean interval between seizure onset and initial presentation at our institution was 7.6 years. Seizures were simple partial in 3 patients, complex partial in 15 and secondarily generalized tonic-clonic in 13. The commonest site of the lesion was the temporal lobe (52%). Multiple angiomas were observed in 5 (24%) patients. Seven (32%) patients were medically-managed with antiepileptic therapy and 14 (68%) underwent either lesionectomy with resection of the epileptogenic zone (9 patients) or temporal lobectomy (5 patients). Mean follow-up time was 4 years (range: 3 months to 14 years). Of the medically-managed patients, 3 (43%) remained seizure-free whereas 4 (57%) continued to have seizures with an average frequency of one per day. Of the surgically-managed patients, 12 (86%) became seizure-free and 2 (14%) had no more than two seizures per year. Surgery appears to be extremely effective in the management of seizures associated with ICA and should receive a strong and early consideration in patients who fail medical therapy.