The occipitocervical region is approached using the far-lateral approach, which is found on anatomical references. This chapter outlines the stages of the far-lateral approach and also some specific accesses. The excision of some lesions around the foramen magnum and some lesions of the cerebellopontine angle growing caudally into the spinal canal is only possible with the far-lateral approach. Although uncommon, complications are possible, the most significant being occipitocervical instability.