Ventricular meningioma of the spinal cord originates from ventricular meningeal cells in the central canal of the spinal cord and grows in an expansile fashion, mostly in the cervical or cervicothoracic segments. Overgrowth or tumor stroke can lead to neurological dysfunction in the corresponding segment. Ventricular meningioma is the most common primary intramedullary tumor of the spinal cord in adults. Most tumors have distinguishable boundaries between the tumor and normal spinal cord tissue, and cystic changes are often seen at the ends of the tumor. Microsurgical resection of the tumor is the treatment of choice, and most of them have good results. However, due to the patients’ and families’ concern about the complications and efficacy of this disease, as well as the difference of surgeons’ surgical techniques, it leads to the delay of treatment and paralysis and other conditions for patients to come back for consultation, which is regrettable. Treatment 1.Small tumor and asymptomatic treatment If the tumor is small and detected by chance without any symptoms, you can review MRI every six months to dynamically observe the tumor changes. If the tumor does not change, it can still be observed; if it grows bigger and symptoms appear, surgery should be considered; if it becomes smaller, there is a possibility of misdiagnosis, so it is necessary to re-establish the diagnosis and treatment plan and review regularly. 2.Small tumor with symptoms Many doctors and patients are reluctant to operate because most of the symptoms are mild and will be aggravated after surgery and new symptoms. I think surgery should be performed, it is difficult to predict whether it will aggravate the nerve damage. 3.Large tumor, but asymptomatic or mild symptoms I have met so many patients who are reluctant to operate, and after several months or six months catastrophic events occur, such as tumor bleeding, paralysis, etc. Therefore, prophylactic surgery should still be clear with patients. 4. High neck medulla, risky tumor Most of the symptoms are heavy, whether to operate or to give up, to communicate well, most of the patients’ families report that they are hopeful and willing to operate. However, it mainly depends on the surgical technique of the surgeon. The surgery was performed using C1-T1 posterior median approach, ultrasonic bone knife to cut through the lamina and intramedullary tumor removal. Intraoperative use of sodium fluorescein imaging showed that the tumor was located in the spinal cord intramedullary tumor intraoperative resection of the tumor is shown below, under the microscope and in sodium fluorescein mode. The spinal cord tumor was completely resected, and the tumor was 11 cm long vertebral plate was repositioned with titanium nail and titanium plate with good anastomosis. Postoperative review MRI showed complete tumor resection and no tumor manifestation. In conclusion, although high cervical medullary long-segment ventricular meningioma is difficult and the risk of paralysis and respiratory impairment is high, without surgery, the tumor itself has a great impact on the patient and there is also a risk of paralysis and respiratory impairment. Therefore, once a spinal ventricular meningioma is diagnosed, it should be actively sought, regardless of size, and patients and families should not take any chances, and for symptomatic cases it should be actively removed surgically, but the experience and skill of the surgeon is equally important.