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Arachnoid cysts possess several features that make them ideal targets for primary endoscopic fenestration. First, the target membrane is typically avascular. Second, there are generous amounts of CSF for optimal image transmission. Third, the technique of membrane fenestration is amply familiar to surgeons regularly practicing neuroendoscopy, principally through the experience of performing endoscopic third ventriculostomy. Lastly, there is no traditional approach that is universally agreed upon as being optimal. While the rationale for primary endoscopic fenestration has been collectively accepted for some arachnoid cyst variants, notably the prepontine arachnoid cyst, there justifiably remains considerable disagreement about its role for cysts