The indications of cranial gamma knife gradually expanded with the deepening of the understanding of the gamma knife and the continuous improvement of the machine. At the beginning, it mainly treated some functional brain diseases, such as tremor palsy, intractable pain, trigeminal neuralgia, etc. Later, it gradually developed into the treatment of brain tumors. The scope of treatment also expanded from intracranial to the treatment of some extracranial tumors, such as orbital tumors and nasopharyngeal tumors, and in recent years for the treatment of glaucoma. 1997, the author in the journal “Medicine and Philosophy” put forward four basic principles for the selection of indications for the Gamma Knife: First, must be a neurosurgeon with extensive clinical experience and a rigorous scientific attitude gatekeeper. Second, must establish a specific patient-specific analysis of the point of view. Third, the pursuit of optimal efficacy must be the first priority of all work. Fourth, the indications for the gamma knife must be viewed with a developmental perspective. Now it seems that this basic principle is still applicable. In summary, the indications for cranial gamma knife include the following aspects: (1) cerebrovascular disease: cerebral arteriovenous malformation (AVM), cerebral cavernous hemangioma (CA), dural arteriovenous fistula (DAVF). (2) Intracranial tumors: including benign and malignant intracranial tumors, such as pituitary tumor, craniopharyngioma, meningioma, auditory neuroma, nerve sheath tumor, chordoma, ventricular meningioma, choroid plexus papilloma, pineal area tumor, glioma, brain metastasis, germ cell tumor, lymphoma, etc. (3) Extracranial tumors: tumors in the orbit behind and inside the eye, such as intraorbital meningioma and uveal melanocytoma. Tumors of the nasopharynx, such as nasopharyngeal carcinoma and sinus cancer. (4) Residual and postoperative recurrent tumors after craniotomy, postoperative cerebral arteriovenous malformations and residual malformed vascular nests after endovascular embolization. (5) Recurrent brain tumors and nasopharyngeal tumors after radiotherapy. (6) Functional brain diseases: trigeminal neuralgia, epilepsy, intractable pain, tremor palsy (Parkinson’s disease), etc. (7) Other: In recent years, foreign countries have also been used for the treatment of glaucoma reported. (8) cranial gamma knife is particularly suitable for the treatment of those located in important functional areas, craniotomy risk of tumors and cerebral arteriovenous malformations and other diseases. In addition, the cranial gamma knife is also a good treatment option for the elderly and frail, combined with other parts of the body with serious diseases that are not suitable for surgery, or those who refuse surgery. The choice of indications for cranial gamma knife is very important and largely determines the effectiveness of treatment, which must be grasped by experienced stereotactic neuroradiologic surgeons. The above is only a list of diseases suitable for gamma knife treatment and the scope of treatment, specific to the individual patient, must be combined with the nature of the patient’s lesion, location, size, surrounding important structures, the degree of risk and other circumstances to make a comprehensive assessment, and then can decide whether or not suitable for gamma knife treatment.