The infratentorial supracerebellar approach is the most commonly used surgical approach for pineal and pineal region tumors in the literature (Mottolese et al. Neurochirurgie 61:176–183, 2015). The infratentorial supracerebellar approach is performed through a natural surgical corridor, which is facilitated by the use of the sitting position. This approach is particularly indicated for tumors that are strictly midline and measure no more than 2 cm in diameter (Stein. Surg Neurol 11:331–337, 1979; Stein. J Neurosurg 35:197–202, 1971; Pendl et al. Neurosurgery 26:641–648, 1990). Advances in surgical microscopy, the development and systematic application of microsurgical techniques and the improvements in anesthesia have all contributed to reducing complication and mortality rates, thereby popularizing this approach. We describe the infratentorial supracerebellar approach to the pineal region and we present how we do it.