Background: Midline suboccipital craniotomy has been proposed as an alternative to conventional craniectomy for removal of posterior fossa tumors.
Method: We describe a modified technique for midline suboccipital osteoplastic craniotomy based on the atlantooccipital membrane for a 17-year-old boy with superior vermian astrocytoma. Osteoplastic craniotomy was performed safely in this patient.
Result: The presence of the turned down, attached bone flap did not interfere with surgery. Reattachment of the bone flap was easy and stable. This technique was not associated with additional risks.
Conclusion: Midline suboccipital osteoplastic craniotomy is a better option for superiorly placed midline posterior fossa tumor surgery.