Mortuary practices of the Pre-Pottery Neolithic Near East have been identified with skull cult and ancestor worship, as a means of creating and eliminating social boundaries. Artificial cranial modification is recognized as related to these practices, but its incidence is under-recognized and the precise nature of its significance is rarely discussed. In this study a skull, not previously reported as artificially modified, was reassessed by radiography to provide further insight on this subject. The cranial modification identified must have occurred in childhood but did not dramatically alter the cranium. We therefore argue that the post-mortem treatment of artificially modified skulls should be viewed in the context of ritual practices that were of significance during life, not just after death.