Primary spinal cord tumors account for 2-4% of all central nervous system tumors. Intramedullary tumors are the rarest type of spinal tumor, accounting for 20-30% of all tumors. Among intramedullary tumors, astrocytomas and ependymomas are the most common. The most common diagnostic tools are magnetic resonance imaging and computed tomography for bone involvement. Preoperative neurological examination is the main factor determining tumor location and grade, which are key predictors of postoperative complications. The prognosis is worse in the presence of preoperative motor deficits. The complication rate increases in the surgical treatment of tumors at the thoracic level. Major complications include postoperative neurological deficits, cerebrospinal fluid leaks, infection, epidural bleeding at the surgical site, bladder and bowel dysfunction, and systemic complications such as pulmonary embolism and deep vein thrombosis. In minimizing complications, appropriate patient selection, correct and safe surgical preparation, and the use of intraoperative imaging are important, along with postoperative rehabilitation. This section compiles potential complications, risk factors, and prevention strategies that can arise after spinal intramedullary tumor surgery.