The foramen magnum meningioma (FMM) is one of the most threatening tumours among the meningiomas because of its specific location, clinical course, subtle onset, and relatively big dimensions at presentation.Tumour size may mandate careful airway management to avoid further brainstem compression. The surgical management of these complex tumours in the posterior fossa can be performed with the patient in several positions. A lot of surgeons believe the sitting position provides important advantages, yet this remains controversial. We report a successful approach to a large FMM resection surgery performed in the sitting position.