Presacral tumor is an uncommon tumor and it has potential for malignant transformation. There are various surgical approaches in presacral tumor surgery. It depends on the size and position of tumor and if it has invaded surrounding organs. Posterior coccygeoplasty has several beneficial aspects for a patient with presacral tumor. It is easy to access to lower lying presacral mass and effective to maintain functions of coccyx. Coccygeoplasty can prevent surgery related injuries of anal sphincter and sacrum. We present a 24-year-old female patient that underwent resection of a presacral tumor through posterior coccygeoplasty and review pertinent literature.