Pineal region tumor: surgical anatomy and approach.

The pineal region is one of the surgically inaccessible areas in the brain. Many neurovascular structures form a formidable obstacle to the operative approach to this region. The approaches suitable for reaching the pineal region are the infratentorial supracerebellar, occipital transtentorial, posterior transcallosal, posterior transcortical and posterior subtemporal routes. Considerations important in selecting one of these surgical approaches are reviewed from the anatomical viewpoint.