Smaller cysts in the pineal region often have no obvious symptoms and are mostly found by chance, and generally do not require treatment, but should be reviewed regularly. If the cyst grows gradually, it can compress the aqueduct and cause obstructive hydrocephalus. Patients first have intermittent headache, gradually the headache worsens, sometimes accompanied by vomiting, treated with dehydrating drugs, the condition can improve in a short time. Pineal cysts cause hydrocephalus, which was previously treated by ventriculo-peritoneal shunt to relieve hydrocephalus, but the cysts continue to increase in size, causing a series of clinical manifestations such as difficulty in upward vision. In recent years, with the development of neuroendoscopic technology, the use of endoscopic third ventriculostomy + pineal cyst-ventriculostomy can relieve hydrocephalus and remove the cause of the disease, avoiding the various complications of ventriculo-peritoneal shunt, and has become the first choice for the treatment of this disease. We performed endoscopic surgery for pineal cysts with hydrocephalus and achieved very good results.