Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 28 1515 1515 Gusti Anindito Study Program of Anesthesiology and Intensive Care, Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Bambang Semedi Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Department of Anesthesiology and Reanimation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Dhania Santosa Department of Anesthesiology and Reanimation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. 2025 12 09 2025 12 15 Occipital meningoencephalocele is a rare neural tube defect presenting challenging anesthetic management due to a difficult airway and risk of sac rupture. This report presents two neonates with different lesion sizes managed using contrasting intubation techniques: lateral positioning with manual finger guidance in a 15-day-old with a massive lesion and microcephaly, and supine positioning with doughnut-shaped cushion support in a 2-day-old with a moderate lesion. Both cases achieved successful first-pass intubation with no intraoperative complications. This comparison demonstrates the importance of individualized airway management strategies based on lesion size and anatomy. https://aacc.tums.ac.ir/index.php/aacc/article/view/1515