Objective To investigate the clinical efficacy of small skull window microsurgery for cerebral paragonimiasis in children. Methods The retrospective study included 25 children with cerebral paragonimiasis who underwent small skull window microsurgery at Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital between January 2015 and February 2018, and all children had intracerebral bleeding at admission and had praziquantel for 4-6 courses after surgery. The surgical treatment effects and outcomes were analyzed and evaluated according to activity of daily living (ADL). Results Among 25 cases, there was no operative complications. All the patients recovered well in 3-36 months at follow-up (median: 18 months). According to ADL, the outcomes of 25 cases were graded as follows: level Ⅰ in 24 cases and level Ⅱ in 1. The number and ratio of eosinophils were gradually decreased in blood routine test, and those were at approximately normal levels after 2-3 months of operation. There was no recurrence in this study. Conclusion The small skull window microsurgery for children's cerebral paragonimiasis seems to have definite clinical effect and relatively low rates of complications. Key words: Paragonimiasis; Central nervous system; Child; Microsurgery; Small skull window