Osteoma is a benign tumor characterized by slow proliferation of compact and cancellous bone. Reports of osteomas originating in occipital bone are rare. We report a case of solitary osteoma arising near the foramen magnum. The patient was a 42-year-old woman who presented to our department with a palpable hard mass in the right occipital region, accompanied by neck pain and headache. Non-contrast computed tomography（CT）revealed a bony tumor protruding from the occipital bone toward foramen magnum. Contrast-enhanced CT demonstrated that the shortest distance between the osteoma and the right vertebral artery was 3.0 mm. The tumor was surgically resected, and histopathological examination confirmed the diagnosis of osteoma. At 6 months postoperatively, both the neck pain and headache had resolved, with no evidence of recurrence. To our knowledge, there are no reports in the literature of an osteoma arising adjacent to the foramen magnum. In the present case, the tumor was located near the foramen magnum, where several critical neurovascular structures pass. Considering the patient’s symptoms and potential for symptom progression or increased surgical risk with continued observation, early surgical intervention was selected. Postoperative symptom relief in this case suggests that, even for osteomas, thorough neurological assessment prior to surgery is essential when the lesion is located near critical anatomical structures.
