<p>Cervical intramedullary ependymomas are rare spinal cord tumors that pose significant surgical challenges due to their eloquent location and narrow operative corridor. To describe the surgical technique, perioperative considerations, and outcomes of microsurgical resection of cervical ependymomas performed in the semisitting position. A retrospective single-center review was conducted of 12 patients who underwent microsurgical resection of histologically confirmed cervical ependymomas in the semisitting position between 2015 and 2024. All procedures were performed under intraoperative neurophysiological monitoring using a posterior midline approach. Clinical and radiological outcomes, extent of resection, and complications were analyzed. Gross total resection was achieved in all cases. No intraoperative venous air embolism or position-related complications occurred. Ten patients (83.3%) improved neurologically, while two developed transient dorsal column dysfunction with preserved motor function. No tumor recurrence or delayed neurological deterioration was observed at last follow-up. Microsurgical resection of cervical ependymomas in the semisitting position is a safe and effective technique when modern anesthetic and monitoring protocols are applied. The approach provides excellent surgical exposure and facilitates complete tumor removal while preserving neurological function.</p>