Three cases of tuberculosis of the vault of the skull are presented. The skull lesion is secondary to a primary focus elsewhere in the body and it is suggested that specific treatment of the primary lesion is responsible to some extent for the apparently low incidence of skull involvement in areas where the overall occurrence of tuberculosis is still high. The 2 forms of lesion which occur are discussed. The essentially similar nature of the underlying pathology in the 2 types is emphasized by their presence at the same time in one of the reported cases. The rapid and almost complete reconstruction of bone which follows specific therapy is illustrated. Addendum: Since completing this report 4 similar cases have been seen, all of which have shown a good response to chemotherapy.