Pineal disease mainly refers to lesions occurring in the pineal region, the more common ones being pineal cysts and tumors in the pineal region. If the diameter of pineal cyst is less than 2 cm and no clinical symptoms appear, regular annual follow-up can be performed, while patients with symptoms need to consider surgery. In the case of pineal region tumors, there is no optimal treatment option, but radiotherapy with experimental doses is available, but controversial. It is currently advocated that histopathological results should be obtained in most cases and that 36%-50% of benign tumors of the pineal region or are insensitive to radiotherapy. It has also been suggested that an experimental radiation dose may be given if the pineal tumor enhances homogeneously on magnetic resonance with the typical presentation of a germ cell tumor. A shrinking tumor can be diagnosed as a germ cell tumor, and radiation therapy can be continued without surgery. Benign tumors or tumors that are insensitive to radiotherapy are not necessary to continue radiotherapy. Other scholars believe that open surgery can be considered for most tumors except germ cell tumors.