Objective To investigate the clinical values of different microsurgical approaches for tumors at the trigone of the lateral ventricle.Methods The clinical data of 47 patients who underwent microsurgery for tumors at the trigone of the lateral ventricle were retrospectively analyzed, and the clinical values of different surgical approaches and surgical techniques were also analyzed.Results A total of 42 patients underwent total tumor resection. Five patients had partial tumor resection because of large tumor sizes and unclear boundaries; among the 5 patients, 3 patients (2 cases of gliomas and 1 case of astroblastoma) also underwent decompressive craniectomy, and 1 patient with anaplastic ependymoma which had grown to the opposite side relapsed after partial tumor resection. One patient with glial sarcoma developed delayed hemorrhage in the surgical area and then had an emergency operation to remove the intracerebral hematoma from the surgical area, but died on the second day. One patient had epidural hematoma at the same side after surgery and achieved gradual absorption through active treatment without the secondary surgery. Five patients had intracranial infection after surgery, and they were cured of infection and achieved good prognosis after continuous drainage of cerebrospinal fluid from the lumbar cistern. The Glasgow Outcome Scale scores at discharge were as follows:39 patients got 5 points, 4 got 4 points, 1 got 3 points, 1 got 2 points, and 2 got 1 point.Conclusions For patients with different types and growth directions of tumors at the trigone of the lateral ventricle, appropriate surgical approaches under the guidance of the imaging navigation system and proficient surgical skills are associated with reduced function damage, reduced complications, and good outcome.