The authors think that the more desirable treatment for pineal region tumors is definitive surgery with a histological diagnosis and that a conservative approach consisting of shunting and radiation therapy no longer seems to be appropriate. We report the result of a retrospective review of the presentation, treatment, and outcome of the seventeen patients treated between June, 1989 and June, 1994. Nine patients were males and eight patients were females, and the age ranged from 13 to 51 years(mean age about 32 years old). Histological verification was available in fourteen tumors;six by an occipital transtentorial approach and five by an infratentorial supracerebellar approach and two by a stereotaxic biopsy and one by a frontotemporal craniotomy for ectopic germinoma. Germinomas were the most common type. Three of the seventeen patients died of tumor progression. Because the great variety of tumor found in the pineal region must be treated in different ways and because improved microsurgical and stereotaxic surgical techniques have made mortality and morbidity rates acceptably low, a biopsy diagnosis should be obtained.