Ventricular meningiomas of the brain are uncommon and typically originate in the ventricular system of the ventricles, and these tumors are most common in children. To date, there are no published randomized clinical trials to guide the treatment of patients with ventricular meningiomas: 1. For ventricular meningiomas of the brain, we recommend total resection of the tumor, rather than biopsy or partial resection, when possible. Clinical observations have shown that patients survive longer with total resection compared to partial resection. 2. For those patients with ventricular meningiomas older than 1-3 years of age, we recommend adjuvant radiation therapy after total resection rather than continued observation and remedial treatment when the tumor recurs. For patients with supratentorial non-mesenchymal ventricular meningioma, under the presence of wide resection margins, complete resection followed by follow-up is the way to go. 3. For those patients with ventricular meningiomas younger than 1-3 years of age, we recommend three-dimensional conformal radiotherapy after total resection. Chemotherapy can be used as an alternative to radiotherapy after surgery, but is recommended only in formal clinical trials. 4. For all patients with incomplete resection of the brain, we recommend postoperative chemotherapy followed by an attempt at secondary surgery with the aim of achieving complete resection. Spinal ventricular meningioma: can be classified as intramedullary, extramedullary subdural or epidural. Primary intramedullary tumors: The most common intramedullary tumors include ventricular meningioma, hairy cell astrocytoma, and diffuse fibrous astrocytoma. Mucinous papillary ventricular meningioma, a subtype of ventricular meningioma, is mainly found in the conus and the terminal filaments of the spinal cord. 1. Surgical resection to the maximum extent possible is the first step in the treatment of intramedullary spinal cord tumors. Complete or near-total resection is more easily achieved in patients with low-grade malignant ventricular meningiomas and hairy cell astrocytomas than in highly malignant ventricular meningiomas and diffuse astrocytomas. 2. For patients with low- or intermediate-grade (WHO I or II) intramedullary glial cell-derived tumors, we recommend postoperative observation rather than radiation therapy for those who achieve total resection with initial surgery. 3. For those intramedullary tumors that are not completely resected (biopsy or incomplete resection only), we recommend postoperative adjuvant radiotherapy. Radiotherapy is also effective for tumors that recur after initial surgery. Extramedullary intradural tumors: The most common are meningiomas and nerve sheath tumors. 1. Subdural extramedullary nerve sheath tumors are either found incidentally or in combination with neurofibromatosis type 1 or type 2. Pathological findings can be classified as Chewang cell tumor, neurofibroma and malignant nerve sheath tumor. 2. Chewang cell tumors and neurofibromas are usually slow-growing tumors whose clinical manifestations are related to the level of the affected spinal cord, whereas malignant nerve sheath tumors are fast-growing. Once the spinal cord is compressed, symptoms may suddenly appear at an accelerated rate. 3. Surgical resection is a good treatment option for most Chewang cell tumors or neurofibromas. For incidental tumors, the prognosis is usually very good. In neurofibromatosis, the multiplicity of tumors is a significant risk factor. Epidural tumors: The vast majority are metastatic. 1. In addition to pain and potentially irreversible neurological impairment, epidural spinal cord compression (ESCC) due to the tumor is a common complication. The three most common malignant diseases include prostate cancer, breast cancer and lung cancer. 2. The most common presentation is back pain, and this symptom is usually the initial symptom. Abnormalities in movement and sensation follow closely behind. Immediate therapeutic intervention is needed in order to prevent irreversible nerve damage. 3, An important step in reducing the potential sequelae of nerve injury is early diagnosis and rapid therapeutic intervention. 4, MRI is usually used as the examination of choice, and CT myelography can be used as an alternative. In addition to causing pain and potentially irreversible neurological impairment, epidural spinal cord compression (ESCC) due to the tumor is a common complication. We consider the presence of indentation to the dural sac on any image as evidence of tumor-induced epidural spinal cord compression. Most cases originate from epidural expansion of metastatic carcinoma of the vertebral body. Rapid diagnosis and immediate treatment are the most important means of preserving neurological function. The goals of treatment for epidural spinal cord compression (ESCC) due to tumor are pain control, avoidance of complications from local lesion progression, and improvement or preservation of neurologic function. The choice of definitive treatment must be appropriate to the burden of the patient’s underlying disease, life expectancy. An important part to consider before treatment is the evaluation of spinal cord stability. For those who either present with neurological symptoms or clear compression of the dural sac, we recommend the use of glucocorticoids as an essential part of the initial treatment. 1. For those with severe signs of neurological impairment (e.g., lower extremity bradykinesia or paraplegia), we recommend high-dose glucocorticoid therapy (dexamethasone 96 mg intravenously, followed by 24 mg four times daily for three days, then discontinued within 10 days). 2. For patients with mild neurological symptoms, we recommend moderate use of dexamethasone. 3. We recommend that glucocorticoids are not indicated for small epidural lesions and for patients with normal neurological function. Decisive treatments include surgery, external irradiation therapy and stereotactic radiotherapy are all treatment options. 4. For patients with metastatic tumors resulting in spinal instability and a relatively good prognosis, we recommend decompressive surgical resection and spinal cord fixation followed by radiotherapy, rather than a single course of radiotherapy, and after surgery, we recommend a long course of radiotherapy. We do not use short-course external radiation therapy. In addition, postoperative stereotactic radiotherapy also helps to improve the control of residual tumor. Patients who have an unstable spine, but are not candidates for open surgery, may benefit from microinvasive vertebroplasty and kyphoplasty followed by initiation of radiotherapy after surgery. For patients with extensive systemic disease, poor general status, and a life expectancy of only a few months, we recommend radiation therapy alone or symptomatic relief. We recommend a short course of radiotherapy rather than a more decentralized treatment plan. 5. For epidural spinal cord compression due to metastatic tumors, we recommend external radiation therapy only rather than surgery for patients with a stable spine (especially for radiation-sensitive tumors such as breast cancer, lymphoma and myeloma). For most patients, we recommend a relatively long course of radiation therapy. 6. For patients with a stable spine and tumors that are not sensitive to radiotherapy (renal cell carcinoma, sarcoma) and for patients without significant spinal cord compression, we recommend stereotactic radiotherapy rather than plain external radiation radiotherapy. If there is clear evidence of spinal cord compression, stereotactic radiotherapy may not be given. If conditions are available, such as patients who are willing to tolerate the treatment process, the disease is not very progressive, and the prognosis is relatively good, it is feasible to first give surgical decompression followed by radiotherapy or stereotactic radiotherapy. 7. For chemotherapy-sensitive tumors (hematologic diseases, germ cell tumors, breast cancer and prostate cancer), chemotherapy and hormone therapy are effective. The benefit of surgery to relieve spinal cord compression compared to radiotherapy is uncertain. 8. Microinvasive approaches such as vertebroplasty, kyphoplasty are only indicated for patients with symptomatic spinal metastases and without significant epidural disease or bone fragments posteriorly washed into the spinal cord. Recurrent epidural metastases causing spinal cord compression – options for re-treatment include stereotactic radiotherapy, repeat conventional radiotherapy, surgery or systemic therapy. The choice of treatment should be individualized.