Abstract The occipital interhemispheric transtentorial approach is commonly used for pineal region tumors. However, there are few reports of this approach for lesions in the superior cerebellum. We present a 47-year-old male patient with an incidental cystic lesion in the superior cerebellum, detected on MRI consistent with cerebellar hemangioblastoma. The patient initially underwent stereotactic radiosurgery. After 5 months he presented with dizziness. A repeat MRI scan revealed an interval increase in lesion size. We performed surgery using the occipital interhemispheric transtentorial approach to remove the lesion. There were no intraoperative complications and the patient tolerated the procedure well. We describe our approach, supplemented by a short video, and review operative approaches to the superior cerebellum.