Patients with brain tumors detected by imaging are often confused: should they have microsurgery or receive gamma knife treatment? Microscopic neurosurgery and Gamma Knife are two completely different types of treatment. In the former, the surgeon removes the tumor surgically; in the latter, the tumor is killed by focused gamma radiation. In terms of short-term results, surgery is more direct because it cuts out the tumor; whereas the gamma knife does not show immediate results. In terms of damage size, microsurgery is more traumatic and risky, while gamma knife is less traumatic, less risky and does not bleed. It can be said that each has its own advantages and disadvantages, and how to choose will require very professional judgment. One of the key factors in the choice is the nature of the tumor Glioma, the most common primary intracranial tumor, is not suitable for the first choice of gamma knife treatment. Because gliomas should be recommended to undergo craniotomy if they are located in a surgically resectable area, postoperative intensity-modulated radiotherapy (WHO class II and above) is generally used. For those that are difficult to remove surgically, stereotactic biopsy is recommended, and radiotherapy is administered after clarifying the pathological nature. For intracranial metastases, if the number of metastases is small, it is recommended to choose gamma knife treatment. For benign intracranial tumors, the size and location of the tumor are critical to the choice of treatment. In the case of meningiomas, for example, large meningiomas need to be treated with traditional surgery. For smaller meningiomas (generally less than 3 cm), gamma knife surgery is the recommended option. Locally: Meningiomas in critical areas, such as intracerebroventricular meningiomas at the base of the skull, are more likely to be treated with Gamma Knife if the tumor is not large. For meningiomas located in convex, non-functional areas, surgical resection is preferred if they are large. Taking auditory neuroma as another example, relatively small tumors (generally less than 75px, but not absolutely) and those with less severe pressure on the brainstem can be considered for gamma knife treatment, but for large tumors and those with severe pressure on the brainstem, craniotomy is generally recommended. The third key factor in the selection is the patient’s age and physical condition For some elderly and frail patients with underlying pathologies (such as emphysema, pulmonary heart disease, hypertension, coronary heart disease, diabetes, etc.), who cannot tolerate traditional surgery and general anesthesia, we recommend appropriate relaxation of the indications for gamma knife treatment. For example, in patients over 80 years of age with a 75px auditory neuroma, we generally tend to recommend the choice of gamma knife treatment. As can be seen, the choice of craniotomy or gamma knife hand is based on the nature, size, location, physical condition and age of the tumor. There are also some tumors that are not suitable for both craniotomy and gamma knife, such as primary central nervous system lymphoma the preferred treatment is chemotherapy; intracranial germ cell tumors, radiotherapy is preferred. Patients must break the misconception that Gamma Knife is risk-free when making choices. Gamma knife rays can cause complications such as radioedema and epilepsy, and may also damage the cranial nerves surrounding the lesion. Only the risks are less than those of microsurgery. In conclusion, each factor that is considered for each patient makes an individualized recommended plan for the patient and family to choose from.