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Nine pineal area lesions were operated upon by the infratentorial-supracerebellar approach. There was one operative death and one death due to disseminated germinoma recurrence 2 1/2 years postoperatively. The remaining seven patients have shown no sign of recurrence and are neurologically normal. The surgical method that has evolved through these nine cases is discussed. The infratentorial-supracebebellar exposure is an excellent one for lesions in the region of the pineal gland, posterior 3rd ventricle, and superior cerebellar vermis. Access is less hampered by the major tributaries of the vein of Galen than with the supratentorial operations. This approach is also a useful extension of the standard posterior fossa exploration when dealing with primarily subtentorial lesions that involve the dorsal midbrain or herniate upward.

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