Background: Anterior and anterolateral meningiomas of the foramen magnum (FM) can be resected either through extensive skull base approaches or through the classical suboccipital midline approach with limited bone removal.
Method: This paper describes the suboccipital midline approach focusing on some peculiar technical features that serve to achieve the necessary space for safe resection of these challenging tumors.
Conclusions: In our experience, by adopting appropriate strategies to gain space (some of them natural, others acquired) the suboccipital midline approach can achieve the safe resection of anterior and anterolateral FM meningiomas in the majority of cases.