Abstract: Objective: to investigate the clinical features, surgical methods and techniques of tumors in the foramen magnum region of the occipital. Methods: from June 2011 to October 2018, 20 cases of tumors in the foramen magnum region of the occipital were treated by microsurgery in our hospital, including 11 cases of meningioma, 4 cases of schwannoma, 2 cases of hemangioblastoma, 1 case of angiothelioma, 1 case of neurofibrosarcoma and 1 case of osteochondroma. According to the origin and main body of the tumor, combined with the characteristics of MRI, the tumor was divided into three types: type I: the tumor was mainly located behind the foramen magnum, including the basilar origin of the foramen magnum. Type II: the tumor was mainly located in the side of the foramen magnum, a total of 6 cases. Type III tumor mainly located in front of the foramen magnum, a total of 4 cases. Three surgical approaches were used to remove the tumor: the suboccipital posterior median approach in 13 patients, the suboccipital retrosigmoid sinus approach in 4 patients, and the suboccipital far lateral approach in 3 patients. Results: total tumor resection was performed in 19 cases and major resection in 1 case. There were no intraoperative deaths, including 1 case of postoperative respiratory paralysis who underwent tracheotomy and died of pulmonary infection 1 month later. Clinical symptoms were improved in 14 cases. Preoperative symptoms were maintained in 3 cases. Postoperative symptoms were aggravated in 4 patients, including new neurological symptoms, limb movement disorder and respiratory paralysis. Conclusion: the effect of microsurgical treatment of tumor in foramen magnum region of occipital is satisfactory. Choosing proper surgical approach according to preoperative position classification is the key to safe and effective tumor resection