Objective To investigate the efficacy， safety， advantages， and disadvantages of microsurgery via the anterior interhemispheric-transcallosal-choroidal approach in resecting pineal region lesions.Methods An analysis was performed for the clinical data of 159 patients with pineal region lesions who were admitted to Department of Neurosurgery， Xiangya Hospital， from July 2010 to December 2018 and underwent microsurgery via the anterior interhemispheric-transcallosal-choroidal approach， including general status， main symptoms， extent of resection， pathological nature of lesion， postoperative complications， and postoperative survival time.Results Of all 159 patients， 143 achieved total resection of lesions， 10 had subtotal resection of lesions， and 6 had massive resection of lesions. Two patients died of subthalamic injury and respiratory failure， respectively， during the perioperative period. Two patients developed extradural hematoma after surgery， which was relieved after hematoma clearance. Four patients had chronic subdural effusion， which had no response to borehole drainage and was relieved after intraperitoneal shunt of subdural effusion. There were 16 patients who developed hydrocephalus after surgery， among whom 2 patients were relieved after endoscopic third ventriculostomy and 14 were relieved after ventriculoperitoneal shunt. The patients were followed up for 6 months to 9 years， with a 5-year survival rate of 81.3%.Conclusions Patients tend to have a good outcome after surgery， and the anterior interhemispheric-transcallosal-choroidal approach is a safety and effective surgical approach for pineal region lesions.