Encephalocele is a broad term representing herniation of cranial contents through a congenital defect in the cranium. The incidence of encephalocele is 1 per 5000 live births.  In this report we present one case of 10 month old infant with large occipital encephalocele who was treated successfully.  Case summary: A 7kg, 10 month old infant presented with a large cystic swelling measuring 30cm×20 cm arising from the occipital region. Infant was placed in the lateral position on operating table. After induction and IPPV, infant was made supine and brought to the edge of the table with an assistant supporting the swelling at the back of head while another assistant stabilizing the infant’s body, taking adequate care to prevent rupture of encephalocele. After intubation and tube fixation, 1500ml CSF was drained from the swelling. Infant was placed in prone position and surgery was completed successfully. Conclusion: For a giant occipital encephalocele, placing the infant’s head beyond the edge of the table provides a good approach to intubate the patient. The removal of large quantity of CSF causes volume and electrolyte disturbances which needs to be corrected perioperatively. We need to pay attention to blood loss, maintainance of body temperature, prone position and its associated complications.