Context: Many approaches were used to remove tumors of the pineal region. None of these approaches could gain general acceptance. Consequently, the choice of the approach is always problematic. Aims: To illustrate and evaluate the usefulness of using the interhemispheric occipital transtentorial approach in treating pineal tumors. Settings and Design: A retrospective study of ten cases of pineal region tumor Materials and Methods: Ten patients suffering from pineal region tumors were operated upon through the interhemispheric occipital transtentorial approach.Results: Three tumors (30%) were easy to dissect from the surrounding and thus were totally removed. Other three tumors (30%) were found adherent to the brain stem and thus sheets of the tumor were left behind i.e. subtotal removal. Four tumors (40%) were very vascular and infiltrating the surrounding and were only debulked. In all the ten patients, the approach was never the limiting factor for tumor removal. When complete surgical excision was not achieved it was due to either a poor plane of cleavage between the tumor and the brain stem, difficulty to dissect the tumor from the deep venous system of the brain or due to invasion of the surrounding vital structures. Conclusion: The interhemispheric occipital transtentorial approach is a suitable approach when treating pineal body tumors.

Keywords: Interhemispheric occipital transtentorial approach; Occipital transtentorial approach; Pineal region tumors; Surgery to pineal region.