Our case report is used to describe a combined supratentorial and infratentorial approach to a giant pineal-region meningioma. The procedure involves section of the less dominent transverse sinus and the tentorium. After the cerebellum and the occipital lobe are retracted away from each other, the operative procedure is carried out. The brain stem and the large veins of this region are better exposed with minimal retraction of the cerebellum and occipital lobe. The transverse sinus is resutured at the end of the procedure to reestablish the blood circulation. The operative procedure is ideal for extensive lesions in the pineal region, providing wide and direct exposure.