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Hacettepe University School of Medicine, Department of Neurosurgery, Ankara The aim of this study was to demonstrate posterior, postero-lateral, lateral, antero-lateral and anterior approaches to the brainstem, and to discuss the indications for each approach. Twenty cadaver head specimens (40 sides in total) were used bilaterally to demonstrate different approaches to the brainstem. The posterior approaches were supracerebellar, combined supra- and infratentorial-transsinus, subtonsil1ar-transcerebellomedullary, and midline transvermian approaches. The postero-lateral approaches were retrosigmoid, trans-sigmoid, and extreme lateral-transcondylar approaches. From the lateral direction, subtemporal-transzygomatic and petrosal approaches were studied. From the antero-lateral aspect of the skull, we performed orbitozygomatic-transsylvian approach, and the anterior approach studied was transmaxillary-transoral approach. Three-hundred and sixty degree visualization of the brainstem was achieved with all these approaches .. The instrument distance required to reach the brainstem via the anterior and posterior approaches was greater than that required with the antero-lateral, lateral, and postero-lateral approaches. A variety of neurosurgical approaches are used to access the brainstem. Good knowledge of the surgical anatomy and of the indications for each approach are essential. However, safely gaining access to the brainstem is always challenging, and further research is needed in this area. Keywords : Brain stem, skull base, surgical approach