The patient was a middle-aged male who was admitted to the hospital with weakness of the extremities with numbness for several months. MRI of the cervical spine suggested a multisegmental enhancing lesion in the medulla oblongata and the cervical medulla, and the imaging diagnosis was: astrocytoma or ventricular meningioma, and demyelinating lesion to be excluded. After admission, surgical treatment was scheduled (intra-medullary lesion biopsy prepared for intramedullary tumor resection + cervical spinal canal decompression and internal fixation) Intraoperative findings: the lesion was yellow and tough, intraoperative freezing suggested: tumor origin, tending to be of epithelial origin. Based on the pathological findings, it was decided to perform a separate resection along the tumor border. The tumor was completely resected microscopically, and due to preoperative spinal cord edema, the C4-5 lamina was resected and decompressed, and lateral block screw fixation of C3-C6 was performed. After screw implantation, intraoperative CB fluoroscopy showed that the screws were well positioned bilaterally. The patient recovered well after surgery and had normal muscle strength in all four limbs.