The pineal region is the second most common location for CNS neoplasms of the supratentorial space in children. Regardless of histology, lesions cause symptoms related to compression of the cerebral aqueduct or invasion of the tectum. The classic feature of a pineal mass is Parinaud's sign, paralysis of conjugate upward gaze. Physiologic calcification within the pineal gland is increasingly common in the second decade of life. However, pineal calcification in a child less than 6 years old must be considered suspicious for pathology.