Dr. Peter Nakaji, professor of neurosurgery, Creighton University School of Medicine, discusses the surgery of the pineal region. Dr. Nakaji incorporates topics of discussion of neuro-endoscopic supracerebellar infratentorial keyhole approach, the role of endoscopy for pineal pathology, supracerebellar infratentorial route, endoscopic approach, principles of endoscopic optimization, the sitting position, lumbar drain, 3-D endoscope, epidermoid tumor, neuroanatomical impact, and retrosigmoid transtentorial.