BACKGROUND: Primary intracranial squamous cell carcinomas are extremely rare, and commonly manifest as malignant transformations of intracranial epidermoid cysts. METHODS: A case of primary squamous cell carcinoma invading the ventral brain stem and the trigeminal entry zone is described. The tumor was microsurgically totally removed via a paramedian supracerebellar approach. Three years after the operation the tumor recurred, and was again totally removed using the same approach. RESULTS: The patient showed no postoperative neurologic deterioration except for a transient deterioration of gait disturbances. The pathologic diagnosis was a recurrence of the squamous cell carcinoma. CONCLUSIONS: Since primary intracranial squamous cell carcinomas grow slowly and have a well demarcated capsule, total removal should be considered whenever possible.