Types of cysts. Non-neoplastic cysts in the pineal region include epidermoid cysts, dermatomal cysts, non-neuroepithelial cysts (e.g., arachnoid cysts), and neuroepithelial cysts (e.g., pineal cysts, glial cysts). Epidermoid cysts and dermatomal cysts are substantial cysts. The surgical strategy is different from other non-neoplastic cysts. It is not discussed in this article. Secondary arachnoid cysts in the pineal region are postoperative conduits that have not regained patency. Cerebrospinal fluid enters the subarachnoid space through the posterior part of the third ventricle and the opening of the arachnoid membrane in the pineal region, while inflammatory adhesions in the operative area gradually form adhesive arachnoiditis. Hydrocephalus recurs, as the cyst communicates with the third ventricle, and the cyst gradually expands with the aggravation of hydrocephalus. Surgical indications and surgical methods. The most common symptoms of non-neoplastic cysts in the pineal region are headache, symptoms of pressure in the tegmental area and hydrocephalus symptoms. cysts are usually larger than 2 cm. asymptomatic patients only need dynamic observation. Most of them do not experience cyst enlargement. Patients presenting with headache alone without large lesions and without hydrocephalus should be cautiously grasped for surgical indications. Indications for surgery for non-neoplastic cysts in the pineal region should be the presence of symptoms that can be explained by the lesion, and/or the presence of hydrocephalus, and/or the dynamic observation of an enlarged cyst. The surgical principle for pineal cysts and primary arachnoid cysts in the pineal region is to open the cyst to the surrounding ventricles and brain pools. Theoretically, fistula is sufficient. However, when we consider a simple fistula. The possibility of recurrence of the cyst due to adhesive occlusion of the fistula after reduction of the cyst is higher. Therefore, partial excision of the cyst wall is preferable. Staged surgery has also been reported abroad. In some patients, the cyst spontaneously resolved after the third ventriculostomy because of the traffic nature of the cyst. Re-operation was avoided. In our opinion, the conduit is usually only purely compressed in such patients. Relief of the cyst compression is sufficient to relieve the hydrocephalus. Staged surgery is not necessary. When the cyst extends more posteriorly, the natural access it provides is more convenient for endoscopic surgery; otherwise, microsurgery is chosen. Postoperatively, secondary cysts often communicate with the third ventricle. Rapid relief of hydrocephalus and cysts can be achieved by performing a triventriculostomy alone. From a preventive point of view, during the initial pineal region tumor resection. Adequate opening of the brain pool in the pineal region. The formation of good communication between the three ventricles and the brain pool can reduce the occurrence of postoperative arachnoid adhesions; it is also advocated that performing a fistula at the base of the third ventricle at the same time as resecting the tumor in the pineal region can reduce the possibility of reoperation.