Direct surgery for intra-axial lesions of the brainstem was done for 9 cases : seven cases in the pons (2 cavernous angiomas, 3 gliomas, 2 metastatic tumors) and two in the medulla oblongata (one cavernous angioma, one glioma), by suboccipital craniectomy. For the lesions in the pons, the supra or infrafacial approach was made. Cavernous angiomas were totally removed. Metastatic tumors were gross-totally removed. Gliomas were partially removed except one case in the medulla oblongata which was removed gross-totally. Suprafacial approach was taken in 5 cases and infrafacial approach was in 2. As surgical results, 7 cases showed improvement of symptoms, and 2 cases, which were operated by infrafacial approach, showed worsening. Cavernous angiomas are good candidate for total removal. Infrafacial approach will required more meticulous procedures than the suprafacial triangle.