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Objective:The aim of our study was to find out the best operative therapeutic regimen by reviewing the comprehension of operation, the improvement of operative method and the selection of operative approach conceing pineal region meningioma combining obstructive hydrocephalus. Methods:We retrospected the clinic data, comprehension of operation and prognosis of 6 cases of pineal region meningioma. Results:Six tumors were all removed, after that the back wall of the up, the manifestation of hydrocephalus disappeared, other symptoms were relieved more or less without any complication with one patient dismissing. The regular MRI examination indicated that the lesions had not reoccur and the cerebral ventricles had been normal. Conclusion:We identify the nourish arteries of the tumor and anatomy relationship between the tumor and its peripheral blood vessels through mode imaging devices, to select reasonable operative method are the premier therapy of pineal region meningioma. The back wall of the third ventricle becomes thin and the suprapineal recess develops shallow and wide, so the third ventricle-quadrigeminal ciste fistulation can effectively eliminate the obstructive hydrocephalus due to the long-term compression on the aqueduct after removing the tumor.