Objective: Cavernous malformation (CM) is an uncommon but important cerebrovascular disease, the neurosurgical management of which often benefits from the use of skull base approaches. Although many CM are cured by the initial resection, residual or recurrent disease may require repeat resection. Strategizing treatment planning for repeat resection is nuanced, with the benefits of a fresh dissection plane weighed against the limitations of an alternative trajectory. We sought to describe our institutional experience with approach selection trends for repeat resection of CM.