Purpose <p>This study aimed to investigate the differences in postoperative complications and prognosis between pediatric and adult patients with pineal region tumors.</p> Methods <p>A retrospective analysis was conducted on a database comprising patients who underwent excision of pineal region tumors, to exam differences in postoperative complications and prognosis between pediatric and adult populations. The patients were divided into three groups. Group 1 included patients with germinoma/mature teratoma. Group 2 included patients with benign lesions or low-grade malignancies (WHO grade 1/2 tumors). Group 3 comprised patients with highly malignant tumors (WHO grade 3/4 tumors or non-germinomatous germ cell tumors).</p> Results <p>A total of 192 patients were enrolled in the study. There were 72 (37.50%) pediatric patients and 120 (62.50%) adult patients. Following pineal region tumor surgery, 142 (73.96%) patients exhibited no significant neurological dysfunction, 39(20.31%) had mild to moderate neurological dysfunction, and 11(5.73%) had severe neurological dysfunction. The rate of death within 30&#xa0;days after surgery was 1.56%. Analysis of risk factors for the severity of postoperative dysfunction of pineal region tumors revealed that patients with partial resection (PR) or those in Group 3 had a higher degree of postoperative dysfunction. In the children subgroup, Group 3 was associated with poorer overall survival (OS) and progression-free survival (PFS), while no statistical difference was found in the adult patients.</p> Conclusions <p>Differences in postoperative complications and prognostic outcomes were observed between pediatric and adult patients with pineal region tumors. Among pediatric patients, Group 3 was more prevalent and correlated with poorer outcomes.</p>