OBJECTIVE: The management of pineal region tumors depends on the histologic subtypes. Two minimally invasive techniques are available: endoscopic intraventricular biopsies and stereotactic biopsies. The recent Southampton and Lille series are the largest endoscopic and stereotactic series of pineal region tumors reporting both diagnosis rate and accuracy rate, respectively; we elaborated on these results in the light of other recent studies. METHODS: We compared the Southampton endoscopic series with the Lille series, reflecting our 25-year experience of stereotactic biopsies, and the metadata of the literature for both approaches, as reported in the 2013 Report of the French-Speaking Society of Neurosurgery on tumors of the pineal region. RESULTS: The results of the Southampton series match the endoscopic literature, in particular regarding the diagnosis rate (81.2%) and the perioperative morbidity (25.0%), and provide a rarely reported accuracy rate (78.6%), giving access to the overall efficacy rate (63.8%). The results of the Lille series match the stereotactic literature and show better results than endoscopic biopsies concerning the diagnosis rate (98.9%), accuracy rate (100%), resulting overall efficacy rate (98.9%), and perioperative morbidity (6.4%). CONCLUSIONS: The Southampton and Lille series provide a unique opportunity to compare the overall efficacy rates of endoscopic and stereotactic biopsies, respectively. The stereotactic approach is safer and more effective for biopsies of pineal region tumors. To improve the safety and reliability of endoscopic biopsies, various methods have to be evaluated: alternative burr-hole strategies, use of neuronavigation, and a combination of flexible and rigid endoscopes.