The occipital transtentorial approach (OTT) is showed to be effective not only for pineal body tumors, but also for superomedial cerebellar tumors. We satisfactorily removed a superomedial cerebellar astrocytoma in a 3-year-old infant using OTT. The magnetic resonance images showed a tumor located in the left superomedial cerebellum, and the distance between the midline and the outer margin of the tumor was 2.5 cm. OTT was performed on the left side, and the tumor was removed completely. Herein, relying on own experiments and some reports, we discussed some helpful techniques and the indications for OTT for superomedial cerebellar tumors. In brief, an arch shift of the superior sagittal sinus to the contralateral side by tracting the dura, a long incision of tentorium, and aspiration of CSF were very useful measures for avoiding occipital lobe injury. We emphasized that a preoperative estimation of possibilities for these techniques is very important.