BACKGROUND: Complete removal of the lesion from the spinal cord cavernous malformation is crucial in patients with spinal cord cavernous malformation. Herein, we report that narrow-band imaging (NBI) is useful to confirm the complete removal of spinal cord cavernous malformations. CLINICAL PRESENTATION: A 45-year-old woman was followed up for the past seven years due to multiple intracranial cavernous malformations. She reported abnormal pressure sensation in the right hip. Thoracic MRI revealed an intramedullary lesion at the 6th thoracic vertebra, suggesting hemorrhage from a spinal cord cavernous malformation. Subsequently, the patient experienced worsening numbness and gait disturbances. The patient underwent surgery using monitoring of motor- and sensory-evoked potentials in the lower extremities. An intramedullary lesion with hematoma was removed using an exoscope and indocyanine green imaging. However, NBI revealed a residual lesion in the removal cavity, which was additionally removed. Postoperatively, the abnormal sensation was alleviated with no loss of motor function. CONCLUSION: NBI is helpful in detecting hidden spinal cord cavernous malformations.