Background Intraoperative localization of cranial bone lesions may be challenging especially when the lesion is not well demonstrated on computed tomography (CT) scan but solely on a radio-isotope bone scan. We hereby demonstrate a technique for localizing such lesions using an intraoperative gamma probe reader and summarize the relevant literature. Methods A case report of a temporal osteoid osteoma causing local pain and unresponsive to conservative treatment is presented. The lesion was demonstrated preoperatively solely on a bone scan, and was intra-operatively localized by a gamma probe reader. Results The lesion was totally excised with normal background readings after lesion removal. Six months after total removal of the osteoid osteoma, the patient is asymptomatic. Conclusion Intraoperative gamma probe reader is a simple, effective, and safe method for intra-operative localization of bone lesions, which are positive on bone scans. It is especially useful for skull lesions that are not demonstrated by other imaging methods. © 2004 Elsevier Inc. All rights reserved.