Objective To investigate the imaging findings and treatment modality for large cavernous sinus hemangioma (CSH).Methods A retrospective analysis was performed for the imaging findings and clinical data of four patients with large CSH confirmed by postoperative pathological examination,and related articles were reviewed.All patients underwent head magnetic resonance imaging (MRI) and computed tomography angiography (CTA) scans,followed by microsurgical resection via the subdural approach.Results The lesions had the manifestations of isointensity on T1-weighted image,short T2 signals with a clear boundary,and FLAIR hyperintensity,as well as rapid homogeneous enhancement or delayed homogeneous enhancement;the tumors also grew into the middle cranial fossa,the sellar region,or the suprasellar region.Head CTA showed no marked feeding arteries in tumors,but there were rich small blood vessels around the tumors.All patients underwent partial resection.The mean intraoperative blood loss was 3425 ml,and 3 patients experienced cranial nerve dysfunction.Conclusions A diagnosis of CSH can be made with reference to head MRI findings.Compared with microsurgery which has great risks,cyberknife radiotherapy has a better clinical effect and may gradually become the preferred treatment modality for this disease.