Intracranial congenital arachnoid cysts are benign intra-arachnoidal fluid collections with a wall composed of arachnoid cells encompassing a cavity containing a fluid similar to cerebrospinal fluid. This cavity frequently communicates with the subarachnoid space. Arachnoid cysts are reported to account for about 1% of all intracranial space-occupying lesions. The most frequent localization of congenital intracranial arachnoid cysts is in the middle cranial fossa, constituting more than half of the cases reported in the literature. We report our use of a fully endoscopic supraorbital approach through the eyebrow for accessing and resecting congenital middle cranial fossa arachnoid cysts. The approach was performed on 2 patients, a 9-month-old infant and a 12-year-old female patient. In both cases, the cysts were resected in their entirety utilizing a 1-cm ‘keyhole’ craniotomy, without the need for a corticotomy and with virtually no brain retraction. The outcomes were favorable and both patients were discharged from hospital within 48 h of surgery. There were no perioperative complications and the cosmetic outcomes were excellent.

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