Objectives: Resection of tumors in or around the region of the anterior third ventricle represent a technical challenge, due to difficulty in approaching these lesions. Several approaches were advocated in order to access the anterior third ventricle through the lamina terminalis. This is a prospective study to compare three common approaches to the lamina terminalis; the anterior interhemispheric, the lateral subfrontal and the orbitofrontal approach, and assess the advantages and disadvantages of each.Methods: Thirty patients, all with anterior third ventricular tumors, were divided into three equal groups. Each group was operated upon using one of the three approaches; Group 1 by the anterior interhemispheric approach, group 2 by the lateral subfrontal approach and group 3 by the orbitofrontal approach. Outcome parameters such as extent of resection, postoperative improvement of symptoms, postoperative complications, mortality, amount of blood loss, operative time and postoperative stay were recorded, analyzed and compared.Results: The average extent of resection was 72% for group 1, 63% for group 2 and 74% for group 3. Postoperative Visual improvement occurred in 66% of patients in group 1, 40% of patients in group 2 and 75% of patients in group 3. Headache improved in 67% of patients in group 1 and 50% of patients in group 3 ( no patients presented with headache in group 2). Two patients in group 2 presented with gelastic seizures and only one of them improved postoperatively. Endocrine and hypothalamic symptoms did not improve in any of the patients in this study. Reported complications were DI (10% in group 1, 40% in group 2 and 20% in group 3), postoperative hydrocephalus ( 10%, 0% and 20% respectively ), visual deterioration ( 0%,0% and 10% ), hypothalamic affection ( 30%, 10% and 20%) and 3rd nerve palsy ( 0%, 30% and 20% ). Mortality rate was 20% in group 1, 10% in group 2 and 20% in group 3. Operative time was almost equal for group 1 and 3 while it was slightly less in group 2. We found no apparent difference between the three groups in terms of blood loss and postoperative ICU stay.Conclusion: There is no significant difference between the three approaches and the choice of approach is highly dependent on the surgeon's preference, previous training and surgical expertise. A surgeon with experience and training on any of the three approaches will definitely obtain a good outcome.