Pilocytic astrocytoma surgery via the pineal region in a 9-year-old boy via the infratentorial-supracerebellar approach.

Pineal region tumors (PRTs) are rare neoplasms located in the epithalamus and account for 2.8-11% of pediatric brain tumors. These patients present symptoms such as headaches, nausea, vomiting, and cognitive decline due to obstructive hydrocephalus. Diagnosis involves advanced imaging (magnetic resonance imaging (MRI) and cerebral tomography (CT)) and biomarkers, with definitive diagnosis often requiring biopsy. Management includes neuroendoscopic biopsy, endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt (VPS), surgical resection, and adjuvant therapies such as chemotherapy and radiation. The choice of treatment depends on the tumor histology and the patient's condition. The prognosis varies, with a 5-year survival rate of 76.2%, which is higher for pineal parenchymal tumors and lower for aggressive types such as pineoblastomas. Despite advancements, outcomes have remained stable, with a recurrence rate of 20.9% and a mortality rate of 11.6%. We present a case of a 9-year-old pediatric patient with a pilocytic astrocytoma in the pineal region. We performed complete resection of the lesion with favorable evolution via the current management of pineal region tumors. Ethics committee approval was not required to perform the surgical procedure on the patient. The patient's parents provided informed consent for the surgery and gave verbal consent for the publication of their images and their surgery.