A case of cervical intramedullary ventricular meningioma resected by neurosurgery applying sphenopalatine laminotomy and repositioning. The patient was a 16-year-old female who was referred to the neurosurgery department for 13 days because of hoarseness and choking coughing with water. Physical examination revealed that the patient only showed bilateral loss of gag reflex, no clear plane of sensory impairment, normal muscle tone, movement, various sensations and reflexes of the extremities, no pathological signs elicited, and normal perianal reflexes. The preoperative MR showed that the tumor was located in the cervical 5-7 medulla and was accompanied by C1-T7 spinal cord cavity. Since the patient’s preoperative sensory and muscle strength of the extremities were normal, tetraplegia might occur after surgery. After total resection of the intramedullary tumor under the neurosurgical microscope, the whole spinal disc was replanted in situ and fixed with a titanium piece and a titanium nail to complete the vertebral canal formation. The spinal cord and nerve root injury were not aggravated. On the third day after surgery, the patient’s limb movement and sensation were normal, his hoarseness and choking cough were significantly relieved, and the bilateral pharyngeal reflexes were restored. On the 7th day after surgery, the patient was able to walk on the ground. MRI showed complete resection of the tumor and significant relief of the spinal cord cavity. The spinal canal structure was anatomically reconstructed in this procedure. Especially for adolescents, it can maintain the stability of the spine after surgery and reduce the occurrence of postoperative complications. Intraspinal tumors have been an advantageous surgical procedure for neurosurgery because neurosurgery insists on microscopic manipulation of the spinal cord and nerve roots in the management of intraspinal tumors, with less bleeding, minor surgical injuries, and rapid postoperative recovery of patients. A case of cervical intramedullary ventricular meningioma was resected by neurosurgery applying sphenopalatine laminotomy and repositioning. The patient was a 16-year-old female who was referred to the neurosurgery department for 13 days because of hoarseness and choking coughing with water. Physical examination revealed that the patient only showed bilateral loss of gag reflex, no clear plane of sensory impairment, normal muscle tone, movement, various sensations and reflexes of the extremities, no pathological signs elicited, and normal perianal reflexes. The preoperative MR showed that the tumor was located in the cervical 5-7 medulla and was accompanied by C1-T7 spinal cord cavity. Since the patient’s preoperative sensory and muscle strength of the extremities were normal, tetraplegia might occur after surgery. After total resection of the intramedullary tumor under the neurosurgical microscope, the whole spinal disc was replanted in situ and fixed with a titanium piece and a titanium nail to complete the vertebral canal formation. The spinal cord and nerve root injury were not aggravated. On the third day after surgery, the patient’s limb movement and sensation were normal, his hoarseness and choking cough were significantly relieved, and the bilateral pharyngeal reflexes were restored. On the 7th day after surgery, the patient was able to walk on the ground. MRI showed complete resection of the tumor and significant relief of the spinal cord cavity. The spinal canal structure was anatomically reconstructed in this procedure. Especially for adolescents, it can maintain the stability of the spine after surgery and reduce the occurrence of postoperative complications. Intraspinal tumors have been an advantageous surgical procedure in neurosurgery because neurosurgery insists on microscopic manipulation of the spinal cord and nerve roots in the management of intraspinal tumors, with less bleeding, minimal surgical injury, and rapid postoperative recovery of patients.