Lateral ventricular tumors are rare lesions of the central nervous system, and because most tumors are benign or low grade, permanent cure can be achieved with complete removal. After adequate preoperative imaging discloses a lateral ventricular mass, the neurosurgeon has several options to choose from when determining the ideal surgical approach to the tumor. The surgical approach cannot be standardized, because the specific location, size, and vascularization of these deep-seated tumors are fundamental elements influencing the choice of surgical approach. Although access to the lateral ventricles may require additional preoperative considerations and planning, the combination of proper knowledge of the cortical and intraventricular anatomy with the familiarity and selection of an appropriate surgical approach will optimize the surgical outcome.