Surgical Approaches to Pineal Region Tumors

Pineal region tumors represent a diverse group of neoplasms arising from the pineal gland and its surrounding structures, posing unique diagnostic and surgical challenges due to their deep midline location and proximity to critical venous and neural anatomy. Advances in neuroimaging, microsurgical technique, and endoscopic technology have transformed their management, substantially improving outcomes compared to historical experiences of high morbidity and mortality. This chapter reviews the anatomical, diagnostic, and surgical principles essential to the contemporary management of pineal region lesions. Detailed descriptions are provided for key operative corridors, including the endoscopic third ventriculostomy with biopsy, supracerebellar infratentorial, occipital transtentorial, posterior interhemispheric transsplenial, anterior transchoroidal, and combined supra-/infratentorial approaches. Institutional experience and outcome data are presented to guide approach selection. Ultimately, optimal management depends on an individualized, anatomy-driven strategy integrating tumor pathology, patient presentation, and the surgeon's familiarity with each corridor.