To operate on pineal region or dorsal midbrain pathology, surgeons should be familiar with several approaches and select one based on what works best for a particular lesion. I think the occipital transtentorial approach is a useful approach that in my experience is used less frequently than the infratentorial supracerebellar approach. It generally has a good view of the vein of Galen, the splenium, dorsal midbrain, and well into the third ventricle. It also has the advantage of easy positioning, unlike the supracerebellar approach. With proper positioning, no fixed retraction is needed, there are no bridging veins in the interhemispheric fissure, and the falco-tentorial junction leads one directly to the pathology. The approach offers a natural corridor along the falco-tentorial junction to the pineal region and dorsal midbrain. One of the challenges of this approach can be to access tumor that extends deeper into the posterior fossa. A helpful trick that I use when splitting the tent is to tack the medial leaflet of the incised tent up against the falx.