Combined approaches are often necessary to address large or invasive skull base pathology. A combined suboccipital craniotomy and neck dissection is often utilized for invasive posterior fossa skull base tumors and neck tumors. Management of these tumors often requires the collaboration of multiple specialties. Tumors in this location are often intimately involved with important neurovascular structures. Good pre-operative evaluation, intra-operative monitoring, and closely monitored post-operative care are essential. The extent of resection and goals of care depends on a case-by-case analysis including the patient’s age, the aggressiveness of the tumor pathology, presenting symptoms, and comorbidities. This chapter reviews the indications, anatomy, and surgical nuances of this complex approach.