A FURTHER MODIFICATION of our operative positioning protocol is presented, with several novel approaches to positioning that give only slightly less exposure than that obtained with the modified prone position, but that enable the entire cranial vault remodeling to be done in one operation. The addition of two techniques has obviated both the need to use the modified prone position (except in certain difficult cases) in recent years and the need to get preoperative cervical spine film evaluation. Two new operative positioning techniques that enable a large calvarial exposure are described: one (the gel-filled collar technique) focuses on the more anterior portion of the cranial vault, and the other (the angled horseshoe technique) focuses on the posterior portion; both provide an extensive exposure of the opposite portion of the calvarium.