Intracranial germinomas are the most common type of intracranial germ cell tumors [1], [2]. These are usually extra-axial, with pineal and suprasellar region locations the most common [1], [3], [4], [5]. In addition to these regions, some unusual reported locations include the cerebellopontine angle, basal ganglia, thalamus, medulla oblongata, corpus callosum, and the temporal lobe [6], [7], [8], [9]. Primary midbrain germinomas are very rare entities, with only eight prior reported cases [10], [11], [12], [13], [14], [15], [16], [17]. Because the differential diagnosis of midbrain lesions can be challenging, accurate diagnosis requires adequate tissue sampling to fully represent the lesion and allow for pathologic differentiation from other entities, such as lymphoma or even glioma [10], [11], [12], [13], [15]. As these lesions are sensitive to radiation and chemotherapy, early histologic diagnosis is critical for proper treatment [2], [15], [18]. In this report, we present a very rare case of a primary intra-axial germinoma of the midbrain. This report also provides the first surgical video of an open biopsy via a transcollicular approach and the microscopic appearance of a primary midbrain germinoma. This report also reviews the current primary midbrain germinoma literature.