<p>Pineal region tumors are challenging entities, primarily due to their location in the posterior third ventricle, and their proximity with fundamental vascular structures, such as internal cerebral veins. Complete removal can be difficult to obtain, yet crucial depending on the histology of the tumor. The video demonstrates the case of a giant ependymoma of the pineal region successfully removed in two procedures through bilateral interhemispheric transtentorial approach: a 4-month-old boy presenting with hypotonia, upward gaze palsy and vomiting in another country. The MRI showed a posterior fossa tumor occupying the quadrigeminal cistern with obstructive hydrocephalus. He was referred to our department after VP shunt positioning, endoscopic biopsy complicated by bleeding, two surgeries that allowed partial removal of the lesion, and a histological diagnosis of ependymoma (ZFTA fusion, WHO III). We performed a two-staged surgery, that allowed complete removal of the tumor.&#xa0; Thefirst procedure was a right posterior interhemispheric transtentorial approach. The second that allowed a complete removal was a left posterior interhemispheric transtentorial approach.</p>