A 58-year-old man was admitted to our hospital upon his request for an operation on a hemifacial spasm that had developed twelve years ago. The hemifacial spasm on the left side was the only positive neurological findings at the time of admission. However, a pre-operative neuroradiological examination revealed a meningioma originating in the falco-tentorial junction. Left neurovascular decompression was initially performed and was followed by the excision of the tumor through a right parietooccipital approach. The pathological diagnosis was meningothelial meningioma. The patient was discharged with no neurological deficit. There have been only a few reports on pineal meningioma and even now this type of tumor is considered to be rare. Some similar cases reported in the literature are reviewed. The clinical aspects, clinical features and the pathological entity are discussed.