Background. Various suboccipital approaches are extensively used in modern neurosurgery for treatment of posterior cranial fossa disease. The main patient’s positions on the operating table during surgery are half-sitting and lying ones. Material and methods. The article provides a detailed description and methodology of retrosigmoid suboccipital and median suboccipital approaches in a lying position. Conclusion. The retrosigmoid suboccipital and median suboccipital approaches in a lying position, when used correctly, provide a good view of the operating field with the minimal risk of complications associated with the patient’s position on the operating table.