Aim:Atrium (Trigone) is the most common site for the intraventricular lesions. Parieto-occipital interhemispheric precuneal approach (POIPA) is one of the particular way to reach these lesions. The aim of this study is to draw specific attention to the surgical difficulties of these lesions and to present our experience by this operative approach. Material and Methods:Sixty-six patients with the lesions located in the atrium of the lateral ventricles underwent surgical treatment in our institution using POIPA over a 13-year period. The clinical, radiological and surgical characteristics of these patients were retrieved and reviewed retrospectively. The histological diagnosis of the cases and postoperative complications were specifically focused in this study. Results:Thirty-six (54.5%) patients were male and 30 patients were female with a mean age 37.9 years (ranged between 8 and 74 years). The lesion was in the right atrium in 25 cases and in the left in 41 (62.1%) patients. POIPA was used in all cases to remove the lesions. The most common tumor was glioblastoma (34.8%), followed by glial tumors grade I, II and III and meningiomas. The other lesions were metastases, ganglioglioma, epidermoid cysts and arteriovenous malformations. Gross total resection of the tumors was achieved in 59 pateints (89.4%) while subtotal removal was performed in 7 cases. Five (7.5%) patients died within the first one month after surgery. Conclusion:POIPA provides safe and effective way to reach lesions located into the atrium of the lateral ventricle. Knowledge of precise anatomy associated with the meticulous surgical techniques decreases surgical morbidity and mortality of the patients.