Skull primary intraosseous cavernous hemangiomas (PICHs) are uncommon, benign, and slowgrowing tumors. These lesions are not widely known, specifically as regards the pathogenesis. The researchers wanted to describe the clinical presentations and radiological characteristics through a literature review of 140 cranial patients who received surgical treatment and histological diagnosis. Although PICH is uncommon, it should always be considered when a hard, steadily expanding skull lesion is seen. Surgical resection should be the first line of therapy for symptomatic individuals and aesthetic motivation, and their long-term results following complete removal are excellent. Moreover, we describe four patients with PICH to enrich the literature.