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Background and Aims Cerebral Cavernomas are vascular malformations that occur in 0.1–0.5% of the population. Despite the highly variable natural history and symptomatic presentation, they all pose a significant concern: cerebral hemorrhage. Among several risk factors, including an inherited bleeding disorder, delivery presents as another crucial one.Methods A 29-year-old pregnant woman, previously diagnosed with 3 cerebellar cavernomas and Von Willebrand’s disease, was admitted for elective caesarian section at 39 weeks. The case required multidisciplinary planning between anesthesia, hematology, neurology and obstetrics. Considering the patient‘s space-occupying lesion stability and hemorrhagic risk, epidural anesthesia was proposed.Results No changes were observed regarding clot factors and ratios. Blood typing and 1 g tranexamic acid were accomplished before neuroaxial approach. While monitored following ASA standards, we proceeded with a lumbar epidural catheter. Here, 90 mg of ropivacaine and 10 mcg of sufentanil were administered, with a total volume of 13 mL, achieving a sensitive block up to T4 level. The surgery and post operative period elapsed without any events and the woman was discharged at day 3 post-surgery.Conclusions Currently there is no consensus regarding anesthetic approach in cerebral cavernomas. Generally, hemorrhage prevention is the main goal, and so are sudden variations in intracranial pressure. Neuroaxial anesthesia emerges as a valid option in obstetrics, since it avoids airway manipulation and hemodynamic changes associated to general anesthesia. This case required careful management of a patient with high-risk conditions for intracranial hemorrhage. Epidural anesthesia proved to be a valid choice, avoiding such severe outcome.