Pineal Region Anatomy

The pineal region is a deep diencephalic extra-axial structure, which floats in a complex cisternal environment surrounded by relevant neurovascular structures. The pineal gland is considered as a neuroendocrine organ, as it regulates some endocrine functions after being regulated by neural signals. The gland is attached to the posterior aspect of the roof of the third ventricle in close relationship with the deep venous system and distal branches of the posterior cerebral and superior cerebellar arteries. Its closeness to the ventricular system, especially the cerebral aqueduct, makes pathology at this level necessary to be excised in many cases due to the compression of the aqueduct and consequent obstructive hydrocephalus. The pineal gland is a pivotal structure located at the center of the posterior diencephalon, floating inside the posterior basal cisterns. These cisterns are delimited by a few arachnoid membranes. The comprehension of these structures remains mandatory in order to understand how tumors in this area grow, and also how to excise them in a safe way. For the latter purpose, understanding the relative location of the gland to the posterior incisural space and falcotentorial junction may be useful to choose the optimal surgical route to this deep area of the human brain.