Neurosurgical lesions of the pineal region are extremely rare, accounting for roughly 1% of the total number of neurosurgical expansive lesions in modern practice. This book offers an up-to-date review of the relevant literature, combined with the personal perspectives of some highly experienced figures in the field. The book is divided into two main parts, the first of which offers an overview of the pineal region from an anatomic, pathologic, imaging and therapeutic perspective. Special attention is given to surgical approaches to pineal region lesions. Microsurgical techniques are presented, together with detailed indications regarding specific locations of these lesions, specific complications, and controversial aspects concerning some of the approaches. A dedicated chapter addresses endoscopic techniques, their indications and limitations. Adjuvant therapies are also discussed, along with their particular indications and debated aspects.