We report a very rare case of treatoma that involves the low brain stem with compression to the fourth ventricle, causing two episodes of aspiration pneumonia. The preoperative impression is ependymoma or astrocytoma. Partial removal of the tumor through a suboccipital craniectomy with postoperative radiotherapy and gets a very good recovery and she could take care of herself without any assistance treatomas of brain stem and find that it may be the second case ever reported.