Neurosurgical lesions of the pineal region are extremely rare, accounting for roughly 1% of the total number of neurosurgical expansive lesions in modern practice. This book offers an up-to-date review of the relevant literature, combined with the personal perspectives of some highly experienced figures in the field. The book is divided into two main parts, the first of which offers an overview of the pineal region from an anatomic, pathologic, imaging and therapeutic perspective. Special attention is given to surgical approaches to pineal region lesions. Microsurgical techniques are presented, together with detailed indications regarding specific locations of these lesions, specific complications, and controversial aspects concerning some of the approaches. A dedicated chapter addresses endoscopic techniques, their indications and limitations. Adjuvant therapies are also discussed, along with their particular indications and debated aspects. In turn, the chapters in the second part cover specific lesions such as pineal region tumors, vascular lesions, and cystic and cyst-like lesions. Regarding pineal region tumors, the most frequent pathologies are presented in the most comprehensive and practical manner possible, with special attention to the appropriate therapeutic management for each type. Further, there is a dedicated chapter on pineal region cysts. Given its depth of content, the book will allow neurosurgeons and specialists to greatly expand their understanding of pineal region lesions in daily clinical practice.