A surgical approach to the anterior lower brainstem and upper cervical spinal cord consists of a fashion of unilateral suboccipital scalp flap, exposure and resection of the suboccipital bone and hemilamina of C1, removal of occipital condyle and the lateral mass of C1 (occasionally). The satisfaction of exposing the anterolateral portion of lower brainstem and upper cervical spinal cord can be obtained with minimal retraction of the nervous tissue. 13 patients, 9 with tumors, 2 with giant vertebral aneurysms, 2 with craniocervical malformations, underwent this operative procedure with no surgical mortality and morbidity which related to the approach.