The posterior transcortical approach directly visualizes the posterior and atrial portions of the lateral ventricular body and is the preferred approach for atrial lesions of the lateral ventricles. The posterior transcortical approach is divided into the superior parieto-occipital approach and the lateral temporo-occipital approach. The superior parieto-occipital approach avoids damage to the optic radiation and reduces the risk of postoperative visual field defects, and in the dominant hemisphere avoids damage to the sensory-linguistic area and prevents the occurrence of sensory aphasia. The lateral temporo-occipital approach allows access to the lower part of the lateral ventricular triangle by incising the superior temporal gyrus, middle temporal gyrus, and the cortex at the temporoparietal junction. The advantage of this approach is that access to the triangle is from the lower part and it is easy to first block the tumor blood supply from the choroid plexus. However, dissection of the temporoparietal cortex in this approach tends to damage the optic radiations leading to isotropic visual field defects, and in the dominant hemisphere it can cause severe sensory aphasia, and should be used in the nondominant hemisphere. In the dominant hemisphere, the superior parieto-occipital approach should be used to resect ventriculomas in the lateral ventricular triangle of the dominant hemisphere because it is necessary to protect the speech center and the ipsilateral visual conduction pathway. The Sanborn Glioma Center applied this approach to resect tumors in the triangle and some thalamic occipital gliomas, and the patients did not have aphasia or visual field defects after surgery.