– Treatment of intramedullary tumors History: Patient Zhang -, male, 49 years old, with numbness in both upper limbs for 3 months. Examination: bilateral ulnar superficial sensory loss in upper limbs, normal muscle strength and tone in all limbs, normal tendon reflexes in all limbs, negative pathological reflexes. Chen Zan, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University MRI could see that the tumor was located in the cervical medulla and completely on the ventral side of the spinal cord. The patient was a middle-aged male with mild symptoms and only slight numbness in the upper extremities bilaterally, while imaging revealed an intramedullary lesion in the cervical medulla, which was initially judged to be an intramedullary ventricular meningioma or astrocytoma. It became a dilemma for the doctor to decide whether to operate on the patient or not. Surgery: Surgery requires a spinal cord dissection to separate and remove the tumor, which will inevitably aggravate the patient’s symptoms and even lead to paraplegia. Is this acceptable to the patient? No surgery: The patient’s symptoms will further worsen as the tumor grows, and even paralysis of the limbs will occur. Moreover, with the increase of tumor volume, the difficulty of surgery will increase and the patient’s symptoms will be further aggravated after surgery, but the patient may be easier to accept the consequence of aggravation of symptoms after surgical treatment because of the severe symptoms already appeared before surgery. Repeatedly communicate with the patient, explaining in detail the nature of the disease, the surgical plan and the various symptoms that the patient may experience after surgery. Repeated explanations were given to the patient’s family to understand the patient’s and the patient’s family’s knowledge of the disease and the level of understanding of possible post-surgical complications. The patient and the patient’s family showed a very good knowledge and understanding of the disease and surgical options and showed good trust in the surgeon. The decision was made to operate on the patient!!! Conclusion: The treatment of intramedullary tumors is still a difficult problem in neurosurgery, and physicians are often faced with a dilemma with their patients. Successful treatment requires the surgeon’s skilled surgical technique, but also requires the patient’s full knowledge and understanding of the disease.