When approaching masses in the pineal region, one must determine if the mass actually arises in the pineal gland or from surrounding structures. The differential diagnosis for pineal region lesions is broad and includes pineal gland lesions, tectal and thalamic astrocytomas, meningiomas, and vascular malformations. Pineal region lesions are relatively infrequent in adults, where they account for 0.4 to 1% of intracranial tumors. However, in children, pineal region tumors represent 3 to 8% of intracranial tumors.