<h4>Purpose of review</h4>To review how the immune microenvironment and oxidative stress modulate the initiation, maturation, and hemorrhagic conversion of cerebral cavernous malformations (CCM) and to appraise the therapeutic potential of immune-directed interventions.<h4>Finding</h4>This project conducts systematic research on the pathogenesis of cerebral cavernous malformation (CCM), focusing on the complex interactions between genetic mutations (KRIT1, CCM2, PDCD10) and the immune microenvironment, oxidative stress, inflammatory responses, and vascular dysfunction. This evidence concerns the gene PDCD10 and famililal cerebral cavernous malformations.