Endoscopic Approach to the Pineal Region

There are three goals in the treatment of pineal tumors: diverting cerebrospinal fluid (CSF) in the case of hydrocephalus, obtaining tissue for diagnosis, and obtaining CSF to identify biological markers. Neuroendoscopy can accomplish all these goals. Two routes can be used to treat pineal tumors. In the transventricular transforaminal approach, the pineal mass is exposed from its anterior aspect. The other route is posterior from a supracerebellar infratentorial approach that resembles the standard surgical approach. It is crucial to recognize that the aqueduct may be compromised and a third ventriculostomy may need to be performed.