A 54-year-old female presented with a two year history of progressive headaches and upper neck pain. The headaches were worse with coughing and bending. Neurological examination was unremarkable including a normal cranial nerve examination. There was no papilloedema. A computed tomogram (CT) demonstrated a midline, posterior fossa, partly fatty, partly solid mass (Figure 1). Magnetic resonance imaging (MRI) demonstrated a mixed fatty, solid mass arising from the fourth ventricle and extending downward below the foramen magnum to the C1 level (Figure 2). The solid portions demonstrated enhancement. In addition, in the lateral right cerebellar hemisphere, there was a second, separate, solid, enhancing mass without any connection to the larger central lesion. A subtotal resection of the tumor was achieved through a suboccipital craniectomy.