The surgical treatment of brainstem tumors is different from that of other intracranial tumors, because of its special anatomical location and functional characteristics, it has its uniqueness, and there are many controversies about the surgical treatment of brainstem tumors, and there are still many important issues that have not been solved. For benign or low-grade malignant tumors with well-defined borders, total surgical resection is possible, and good therapeutic results and good quality of survival can be achieved. For some malignant tumors can play a role in reducing tumor volume, alleviating symptoms and creating opportunities for the next comprehensive treatment. Strict mastery of surgical indications, selection of appropriate surgical approach, skilled microsurgery technique and adequate preoperative preparation are the keys to successful surgery, and postoperative radiotherapy is necessary for malignant tumors that still have residual surgery. The clinical symptoms of brainstem tumor are complex and varied, and the severity of symptoms sometimes does not correlate positively with the volume of tumor, some patients have a large volume but the symptoms are very mild, most patients have dizziness and ataxia as the main symptoms, headache and vomiting and other high cranial pressure symptoms are not obvious. In recent years, due to the further understanding of brainstem structure and function and the improvement of examination means and microscopic instruments and techniques, surgical resection of brainstem tumors has been realized. The brain stem has great plasticity, including its morphology and function, but it is still a difficult challenge for neurosurgeons. We believe that whether a tumor can be completely resected is mainly based on whether there is a distinguishable interface between the tumor and the brain stem. Therefore, accurate judgment of the glial proliferation zone is the key to determine the extent of tumor resection. We have learned that as long as the tumor is limited in growth and the glial proliferation zone is obvious, the tumor should be resected as much as possible regardless of the size of the tumor, because this is the key to determine the patient’s prognosis, and these patients often do not have serious complications due to surgery [1]. In contrast, for small tumors, the brainstem tissue around the tumor is thicker, and the brainstem damage is more serious. The histological type of brainstem tumor is closely related to the degree of surgical resection. Surgery has satisfactory results for benign brainstem tumors and limited well-differentiated tumors, and for some malignant tumors it can play a role in reducing tumor volume, alleviating symptoms, and creating opportunities for the next comprehensive treatment[2] . However, it is not effective for diffusely growing gliomas.