Minimally invasive approaches to the pineal region.

The present review assesses how to make pineal surgery, refined over decades, better, ie, less invasive, while still respecting this delicate region, and achieving anatomic and oncologic goals. An explication of anatomic principles of this region, and some basic surgical principles of keyhole surgery are provided to further assist those interested in minimizing surgical impact during pineal surgery. Although this review, for the sake of brevity, focuses on the infratentorial-supracerebellar approach, many of these principles can be adapted to other approaches, such as the occipital transtentorial, without excessive imagination.