What are the general surgical approaches to this region?
A posterior fossa craniotomy, approaching the pineal gland below the tentorium is probably most commonly used. If a large mass is present and the ventricles are enlarged an endoscopic approach via a frontal burr-hole can also be used.
The cystic pineal region mass (yellow) compresses the tectum of the midbrain (green) and displaces the internal cerebral veins (blue) which are located above it. Inside the mass a fluid fluid level is present with CT hypderdense and T2 hypointense component layering dependently (red) representing the red blood cells / haematocrit above which floats the serum (orange). On T2 weighted images septations are seen to cross the mass.