The outcomes of stereotactic biopsy (STB) of pineal tumors are presented. This diagnostic approach was applied in 51 patients aged 7 to 59 years (mean 23 years) and its main indication is to develop an adequate treatment policy by specifying the histological structure of a tumor. Informative morphological samples were taken in 42 (82%) cases. One patient died, another developed a persistent neurological defect after STB. A third of all cases was diagnosed as having germinomas and other 5 patients were found to have germinative cellular tumors of mixed structure, which reflects the views on the policy of examination and treatment of patients with pineal tumors and indications for the biopsy, which have been established at the N. N. Burdenko Institute of Neurosurgery, Russian Academy of Medical Sciences. In 14 cases, STB diagnosis was verified from 1 to 46 weeks of postbioptic surgery connected with tumor removal or autopsy. There was 100% coincidence in histological diagnosis. Indications for STB in patients with pineal tumors, the significance of its findings, methodological and technical aspects, as well as the clinical value of this diagnostic procedure are dealt with in the paper.