Aim In this study, we operated 22 patients with brainstem tumors between 2010 and 2023 and compared our results with the existing literature, thereby sharing our knowledge and experience in managing brainstem tumors. Materials and Methods We performed surgery on 22 patients with brainstem tumors using various approaches to access the pathology. Our goal was to achieve total or gross total resection, although this was not possible in all cases. Spontaneous breathing was preferred during surgery, and resection was halted if any disturbance occurred. Bipolar or monopolar coagulation was avoided, and smooth compression and irrigation were used for bleeding control. Neuromonitoring was employed during surgery for all patients. Results Among the 22 patients included in this study, 4 presented with long tract symptoms, 3 had hydrocephalus, 5 had papillary stasis, 4 had cerebellar findings, 3 had gait disturbances, 1 had respiratory disturbance, and 1 had dysphagia. Gross total resection was achieved in 10 patients, near-total resection in 4, and partial resection in 8. Conclusion Surgery is a key treatment approach for brainstem tumors. It enables histologic diagnosis, improves symptoms, eliminates mass effect, and reduces malignant and stem cells. While gross total resection is recommended for brainstem tumors, it is crucial to exercise caution and avoid insisting on it in all cases as many midbrain, medullary, and cervicomedullary tumors are focal, exophytic, and benign. Partial, subtotal, and near-total resections can provide long-term survival with favorable prognoses. Moreover, monitoring for deterioration in heart and respiratory rhythms is crucial during surgery for brainstem tumors. Furthermore, surgery should be performed with maximum exposure and minimal retraction. Gross total resection can be achieved if the tumor has created a space by displacing tissues and if an entry point is detected. However, infiltrative, invasive tumors that spread through the tractus are currently inoperable, although exophytic components