OBJECTIVE: Resection of thalamic cavernous malformations (CMs) is controversial. The goals of this study were to evaluate the outcome of thalamic CMs after surgical resection, assess predictors of prognosis, and review the literature. METHODS: The authors used the modified Rankin scale (mRS) to retrospectively evaluate the presentation, surgery, and outcomes of 27 consecutive patients who underwent thalamic CMs microresection using six different approaches between 1998 and 2010. RESULTS: Forty-eight hemorrhages occurred in 27 patients (13 men, 14 women; mean age 33.9 years) with a preoperative mRS score of 2.6 +/- 1.0 and a preoperative bleeding rate per patient year of 5.2%. Complete resection was achieved in 26 patients (96.3%) without surgical mortality. The postoperative mRS score at discharge was 1.9 +/- 1.0. One lesion rebled 1 month after complete surgical resection. After a mean follow-up duration of 48.7 +/- 43.2 months, the mean mRS score was 1.2 +/- 1.2 and the postoperative rebleeding rate was 0.91% per patient-year. With regard to neurological function, 81.5% of patients improved, 11.1% stabilized, and 7.4% worsened. Good outcomes (mRS score <= 2, living independently) were achieved in 21 patients (77.8%). Long-term surgical morbidity was observed in five patients (18.2%). A multivariate logistic regression analysis identified age (<40 years) as the only predictor of the postoperative mRS score (<= 2) (odds ratio, 1.24, 95% confidence interval, 1.02-1.52; P = 0.035). CONCLUSIONS: To our knowledge, this is the largest case series reported in the literature to date. Patients with thalamic CMs can obtain a favorable prognosis using microsurgery; an appropriate microsurgical approach contributes to an excellent outcome.