Objective : To analyze the clinical features and diagnostic and treatment effects of fourth ventricle tumors, and to summarize the experience of microsurgical treatment. Results : 1: medulloblastoma 14 cases (37.8%), male to female ratio 1:1, age of onset 1.4-61(12.5) years; ventricular meningioma 12 cases (32.4%), male to female ratio 1.4:1, age of onset 7.3-55(22.9) years; hemangioblastoma 6 cases (16.2%), male to female ratio 1:1, age of onset 29-60(43.8) years; other There were 2 cases of choroidal papilloma, 1 case each of hairy cell astrocytoma, cholesteatoma and glioblastoma.2: Clinical onset of headache and dizziness was found in 29 cases (78.3%), vomiting in 20 cases (54.1%), and ataxia in 14 cases (37.8%).3: Surgery was performed by posterior middle-inferior earthworm combined with the mediolateral cerebellar fissure approach, with the rate of total excision being 81.0%, and the rate of subtotal excision 19.0%, with no fatal cases. The total resection rate was 81.0% and the subtotal resection rate was 19.0%, and there were no fatal cases. CONCLUSIONS: Surgical approach using posterior median inferior earthworm combined with cerebellar medullary fissure can significantly increase the total resection rate and reduce postoperative complications; intraoperative approach using the first to expose the superior portion of the midbrain conduit, and the lateral side was exposed all the way to the adhesion and invasion with the choroid plexus, can increase the total resection rate.