The relative rarity and anatomical position of presacral tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and surgical approach of 4such tumors(teratocarcinoma 1, endodermal sinus tumor 1, chordoma 1, neurilemmoma 1) have therefore reviewed. Low back pain or sacral pain was present in 3patients although all tumors were palpable on rectal examination. Surgical resection was carried out using the posterior transverse approach in Kraske's prone position. Complete surgical excision was performed in 3cases(chordoma, teratocarcinoma, neurilemmoma) and incomplete excision in 1 case(endodermal sinus tumor). A review of literature concerning these tumors and the surgical approach are presented.