The brainstem is the center of life. It is the “hub” of the nerve center, which is responsible for wakefulness, respiration, circulation and other vital functions. Because of its extremely complex anatomy and physiological functions, surgical treatment of brainstem lesions has been considered a no-go area for many years because of its high risk and poor treatment results. With the development of modern imaging, neurophysiological techniques and microsurgery, many successful resections have been reported at home and abroad. Brainstem tumors account for about 2.4% of intracranial tumors and can occur in any part of the brainstem, with a higher incidence in the brain bridge. In the past, brainstem tumors have long been regarded as a restricted area for surgery because of technical impossibility, physiological impermissibility and anatomical inaccessibility. With the development of imaging and the application of modern microscopic techniques and ultrasound suction, surgical resection of brainstem tumors has become possible. MRI is the best method for brainstem tumor examination, which can clearly show the location of tumor in the brainstem, its growth pattern and the adjacent anatomical relationship, so that the surgical plan can be formulated, the surgical access can be selected and the treatment effect can be judged. The purpose of surgery is to remove as much tumor as possible under the condition of preserving neurological function, so as to release the compression on brainstem, open the cerebrospinal fluid circulation pathway, relieve intracranial hypertension, preserve normal neurological function as much as possible, and create conditions for further comprehensive treatment, thus prolonging the life of patients or improving the quality of life. If the tumor is endogenous and confined to the superficial part of the brainstem, surgery can be considered for brainstem tumors with progressive development of neurological dysfunction. It is worth noting that in addition to the above, personalized, social, psychological and economic factors such as the patient’s age, requirements for postoperative quality of life, what the surgery can achieve, and whether the risk-to-benefit ratio is reasonable should also be taken into consideration. Whether the patient can be operated is the first step, and the extent to which the patient can recover after surgery is more important than the first step. The inferior median occipital approach is the most used approach. Statistics show that most brainstem tumors are located in the pontine and median brain, and most of them are located in the dorsal side of the brainstem. The dorsal brainstem should be dissected along the median or paramedian line to avoid damage to the facial nerve. The “superior facial nerve triangle” between the medial longitudinal fasciculus, facial nerve and cerebellar arm and the “inferior facial nerve triangle” between the medial longitudinal fasciculus, medullary ridge and facial nerve are two areas with few important neural structures, and postoperative complications are less if the brainstem is incised through these two triangles. The cranial exposure is performed by using the suboccipital midline approach. Good microsurgical technique is necessary for brainstem tumor resection. The operation should be meticulous, gentle and accurate to avoid pulling the brainstem and crushing injury. For endogenous tumors, the tumor can be resected intra-tumor first to achieve sufficient decompression effect, and it is not necessary to cut the tumor completely; for exogenous tumors, most of the tumor outside the brainstem can be removed first, and then the residual tumor in the brainstem can be removed according to the method of endogenous tumor resection. The tumor in the latch of medulla oblongata is prone to respiratory arrest, so total resection of the tumor should not be pursued. Autonomic respiration should be preserved during the operation, and the changes of its rhythm, heart rate and blood pressure should be noted to avoid irreversible respiratory disturbance. Intraoperative brainstem evoked potentials and short latency somatosensory evoked potentials should be used to reduce brainstem injury, provide objective indicators for predicting prognosis, and protect the brainstem and brain nerves to the greatest extent possible, even if most symptoms are reversible, to avoid further aggravation of brain nerve damage after surgery. The correct management of brainstem tumors in the perioperative period] is an important factor to ensure the success of surgery. Therefore, patients with brainstem tumors should be closely observed for changes in vital signs and actively prevent and treat various complications after surgery. One of the most serious complications is respiratory disorder, which is mostly caused by brainstem edema or inappropriate brainstem repositioning caused by surgery. In foreign countries, respiratory pacing therapy has been implemented to prevent and treat respiratory disorders. Due to respiratory impairment, coughing and swallowing reflexes are lost, resulting in increased respiratory secretions and retention, which can easily lead to respiratory failure and pulmonary infection, so tracheotomy should be performed when appropriate and ventilator-assisted breathing is necessary. Stress ulcers mostly appear 3-5 days after surgery, and upper gastrointestinal bleeding, which can be treated well with timely application of Loxac. In addition, hyperthermia is also a common complication after brainstem surgery, which can lead to increased blood-brain barrier permeability and cerebrospinal fluid secretion, aggravating cerebral oxygen consumption and cerebral edema, so effective drug and physical cooling measures should be taken in time.