The traditional laminectomy approach may cause spinal instability and spinal deformity in the management of cervical intramedullary ependymomas，especially for young patients. In order to reduce post-laminectomy spinal deformity, we used a unilateral approach, called unilateral multilevel interlaminar fenestration, in the surgery of intramedullary ependymomas. In this 3-D video, we introduce this approach used in the case of a 22-year-old man，who presented with muscular atrophy of both hands caused by an intramedullary ependymoma at C4-7. In this approach, only unilateral interlaminar bone was removed, and the median part of the lamina was preserved as bone bridges. The bone bridges were a little wider than the thickness of the lamina. The rostral and caudal ends of the bone exposure should cover both ends of the tumor. The base of the spinous process was also removed to provide a good view of the contralateral spinal canal. The interspinous ligaments, the contralateral muscles, and the contralateral lamina were preserved well. Both the dura and spinal cord were incised in the post-midline. The durotomy and myelotomy were not joined together under the bone bridges. Piecemeal resection was used for removal of the tumor. Right-angled dissectors were used to dissect the tumor around the bone bridges, and the tumor here had to be removed through the two neighboring bone windows in oblique visual angle. Complete resection was achieved and postoperative MRI revealed that there was no residual tumor and no spinal deformity. The patient had an excellent functional outcome.