Pineal tumors are rare and it is important that they have to be treated by actors involved in their care. The first thing to do is the realization of the routine radiological studies necessary to establish if the tumor is located only in the pineal region or if there is bifocal localization or if the tumor is associated with a metastatic diffusion. Cerebral MRI represents the golden standard for diagnosis, associated, especially in children, to a spinal study. The study of pineal markers, the alpha protein, total human choroid gonadotrophin (hCG), and the free beta HCG, in the blood and in the CSF is of paramount importance to avoid unnecessary surgery because their presence means that we are in the face of a germ cell tumor. The age of patients is an important factor to consider because some lesions are more frequent in the pediatric age, in contrast to other tumors, which are more frequent in adult age. The decision of the choice of treatment sometimes can be difficult and for this the discussions in multidisciplinary concentration groups are necessary and these discussions should be organized also in emergencies to ensure all patients, at any time, are guaranteed of the best treatment. Surgery has a great place for treatment of benign lesion, while chemotherapy and radiotherapy have to be reserved for more malignant tumors according to the definitive histological and genetic studies of the lesions.