Cerebral cavernomas (CCMs) are among the most common intracranial vascular lesions and are present in 0.4%-0.9% of the population. 1,2 Clinically significant hemorrhagic sequelae is the most concerning outcome seen in up to 24% of newly diagnosed brainstem cavernoma. [3][4][5] Conservative management is accepted by expert consensus to be a reasonable management strategy except after multiple, life-threatening hemorrhage or in young patients where most favour surgery. 6 A good understanding of the anatomy of the far-lateral approach and brainstem entry zones is critical to their successful use in brainstem cavernoma surgery. [7][8][9][10][11] The patient was a female in her 20s, with no family history of CCM, prior radiation, or other comorbid conditions. She presented after a 3-week history of progressive headaches associated with left-sided hemisensory disturbance. The patient consented to the procedure and to the publication of her image. MRI revealed a cystic lesion consistent with recent subacute hemorrhage, with a pontine CCM intimately related to the cavity and a contralateral CCM. The CCMs were associated with a type 3 developmental venous anomaly (DVA) with a prominent draining vein draped over the dorsal aspect of the hematoma. The cavernoma was resected after 2 surgical attempts. The peritrigeminal entry zone initially was chosen to avoid the DVA but failed to provide safe access in the absence of an endoscope. Complete resection of the CCM with preservation of the DVA was achieved through the infrafacial corridor at a second surgery. We discuss the technical nuances of using 2 different brainstem entry zones to resect a brainstem cavernoma.