Treatment of saddle zone occupancy with hydrocephalus mainly includes surgical resection of the saddle zone occupancy and radiation therapy, with ventriculoperitoneal shunt surgery if necessary. When the saddle region is large, it may affect the circulation of cerebrospinal fluid, which may lead to hydrocephalus. Therefore, the first consideration is to resolve the saddle region causing hydrocephalus. Surgery is preferred to remove the brain tumor to resolve the cerebrospinal fluid circulation obstruction in cases of saddle occupancy, whether it is a pituitary tumor, craniopharyngioma, or germ cell tumor. Radiation therapy can be used to further reduce the size of the tumor, delay recurrence, restore normal cerebrospinal fluid circulation, and relieve hydrocephalus in cases where the tumor cannot be completely removed by surgery. If the hydrocephalus is still not completely relieved after the above mentioned surgery and radiotherapy, hydrocephalus shunt surgery can be considered, and the common way is ventriculoperitoneal shunt surgery. Patients with saddle region occupation and hydrocephalus should go to the neurosurgery department of regular hospitals, and the corresponding treatment plan should be decided according to the nature of the tumor and the degree of hydrocephalus in the saddle region occupation.