The posterior cranial fossa, containing the midbrain, pons, medulla, cerebellum, and fourth ventricle, includes a dense concentration of neurophysiological pathways, areas, nuclei, and vasculature. The deficits resulting from pathologies common to this area and potential injuries from surgical treatments to remedy these pathologies can result in life-altering neurologic deficits or death. Key to increasing the likelihood of a good surgical outcome is an adequate understanding of the common pathologies that affect the neurological structures of the posterior cranial fossa, the anatomical structures within it, the various surgical approaches, the neurologic structures at risk, and the correct neuromonitoring tools required to protect these structures.