Today, I saw a case of germ cell tumor patient’s treatment, and I have the urge to write something about it, hoping to provide some medical knowledge to avoid further detours in the treatment of this kind of disease. Germ cell tumors and germ cell tumors are two different concepts: germ cell tumors are only one type of germ cell tumors, which can account for about half of germ cell tumors. Germ cell tumors also include embryonal carcinoma, teratoma, choriocarcinoma, and other diseases. Most germ cell tumors occur in the midline area of the body, and are most common in the pineal region, thalamus, hypothalamus, pituitary stalk and other areas. Among them, pineal and saddle areas are the most common. However, there are other tumors in the pineal and saddle areas. For example, germ cell tumors, tumors of glial cell origin, tumors of pineal cell origin, and other rare tumors such as meningiomas can occur in the pineal region. Germ cell tumors have their biological indicators in blood and brain crest fluid, and usually require both blood and brain crest fluid tests for HCG, AFP and CEA, which can help in differential diagnosis and guide treatment. The cranial MRI is also an important indicator to help diagnose and guide the treatment. In the past, because of the deep location of germ cell tumors and the fact that most of them are sensitive to radiotherapy, all experimental radiotherapy was chosen. However, different opinions have been formed abroad regarding the treatment of this disease. For germ cell tumors, if the AFP and HCG are greater than 50, we can consider that the AFP and HCG are positive and surgery is preferred. If the AFP and HCG are relatively low and negative, surgery is also recommended as the first choice of treatment if there is inhomogeneous enhancement, calcification or cystic changes on MRI. Experimental radiotherapy is only recommended if there is homogeneous enhancement and both AFP and HCG are negative. 20 CGY is usually given first and surgery is recommended if it is not effective. At present, there are different opinions abroad for germ cell tumors that are sensitive to radiotherapy. The main reason is that radiotherapy leads to more serious complications of radiotherapy while controlling the tumor, mainly intellectual problems and neuroendocrine problems, and the patient develops intellectual decline and developmental arrest with total pituitary function, therefore, for germ cell tumors, chemotherapy is beginning to be recommended as the first choice abroad. However, the current cure rate of chemotherapy is around 65%, which still does not reach the effect of high-dose radiation therapy, which is around 85%, and is therefore still in the research phase. The current consensus is that if the tumor is larger than 2 cm, surgery is recommended as the first choice. The most important reason that hinders surgery is the perioperative death and disability rate, which is reported abroad as 0-8% mortality and 0-25% severe disability. The occurrence of surgical complications depends on the type of tumor and the operator’s experience and microscopic technique. Generally speaking, pineoblastoma has the highest rate of death and disability. The reason is that the tumor has a strong blood supply, which is the most important reason for the difficulty of surgery. At present, based on the MRI film, we assess the surgical risk and decide the surgical approach based on four aspects: surgical access, tumor texture, tumor blood supply and tumor encirclement of the internal cerebral vein, and have achieved relatively good surgical results. From our current experience, the patients selected for surgery based on nuclear magnetic and biological indices, the tumors are mostly mixed, i.e., teratoma contains a small amount of germ cell tumor and yolk sac carcinoma components, and a few are other germ cell tumors, one case is choriocarcinoma and one case is embryonal carcinoma. Therefore, as doctors must tell you that the choice of treatment for germ cell tumors is very important, and the standard treatment is likely to be surgery, then chemotherapy, then radiotherapy. But because surgery is risky and traumatic, many patients choose direct radiotherapy. Maybe the patient does have pure germ cell tumor or pineal cell tumor combined with lymphocytic infiltration, then you have chosen the right choice. But many patients may be in a more embarrassing situation and the next step of treatment is very difficult.