We report our preliminary results (seven cases) with a three-quarter prone approach to the pineal-tentorial region using an opening beneath the midline. The technique we have used eliminates the risk of air embolism because the head is just over the right atrium, the table remaining in an horizontal plane. Using the natural effect of gravity, it is no more necessary to use retraction on the occipital lobe. So, hemianopsia is eliminated. We confirm the results of other teams who have used this approach which seems to us to be the best way to treat any lesion in the pineal-tentorial area.