Abstract： Objective To discuss the clinical feature,treatment strategy of childhood intracranial tumors originating in basal ganglia and thalamus.Method The records of 66 children who suffered from tumors arising from basal ganglia and thalamus based on iconography and treated in Shanghai Huashan hospital were reviewed retrospectively.Based on the histology,patients were divided into Frameless image - guided biopsy group and craniotomy group for analyzing its prognosis by survival rate,complications,operating time,hospital stay,and treatment effect.Results In these 66 cases,there were 16 cases of high grade glioma,14 low grade glioma,9 pilocytic astrocytoma,19 germ cell tumors,1 lymphomas,and 7 other tumors.All patients were treated surgically.The tumor was totally removed in 27 cases,sub -totally in 14,and partially in 6.Frameless image - guided biopsy was performed in the other 19 cases.59 patients (89.4％) were successfully followed up.The common 5 -year survival rate was 65.2％.For high and low grade glioma,germ cell tumors,there was no significant different between Frameless image -guided biopsy and craniotomy group in prognosis of survival rate ( P ＞ 0.05 ).The reliability ratio,postoperative hospital stay time of frameless image - guided group were better than that of craniotomy group while the sequelae and complication ratios of frameless image - guided biopsy group were much lower than that of craniotomy group (P ＜ 0.05 ).COX analysis showed the only factor which influent post - operative survival rate was the histology of tumors (P ＜ 0.05 ).Further logistic analysis showed the histology of tumors and the degree of pre- surgical movement disorder were strongly correlated with movement disorder post operation.Conclusions Frameless image -guided biopsy is the first choice for childhood brain tumors originating from basal ganglia and thalamus,except hemangioma that were obviously confirmed by iconography.Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) can help to choose surgical approach and predict prognosis.This treatment strategy not only can make the pathological diagnosis for further treatment,but also can reduce the sequelae and preserve the neuro - function.