We experienced 22 cases of spinal intramedullary tumor, in which 5 cases were accompanied with exophytic growth. We discussed their clinical and radiological features, and therapeutic problems. Concerning the locations of tumors with exophytic growth, the most common site was conus medullaris, accounting for 60% (3 cases). Histopathological findings were astrocytoma in two cases, and in one case, mixed glioma, ependymoma and hemangioblastoma. In neurological observation, the most common initial symptom was back pain and lumbago, suggesting root pain. No neurological features distinguishable from those of extramedullary tumors were presented. In radiological examination, myelography and CT myelography were very helpful for diagnosis. Myelography and CT myelography showed extramedullary mass, shift and deformity of spinal cord that was not serious as compared with the size of extramedullary mass, and showed the portion where the spinal cord was swollen. Good outcomes were obtained in a case with total removal, and two cases with subtotal and partial removal that were managed with additional irradiation and chemotherapy. However recurrence and intracranial seeding made prognosis poor in two cases where total removal was impossible. We thought that postoperative careful follow-up was necessary not only to detect recurrence but also to detect intracranial seeding in the cases of spinal intramedullary tumor with exophytic growth.