Background: Arachnoid cysts are benign, extra axial, cystic lesions, filled with cerebrospinal fluid, formed due tocongenital splitting of thearachnoid layer. In the relatively uncommon event of these cysts becoming symptomatic, clinical manifestations are usually related to mass effect on adjacent structures including ventricular obstruction and subsequent hydrocephalus. With modern treatment techniques, debate continues regarding which surgical treatment is most effective. Objectives: The aim of this work is to find which one of surgical treatment is more effective for arachnoid cyst of the brain, shunt or microscopic fenestration surgery. Patients and methods: This cohort study was conducted on twenty patients presented with symptomatic cranial arachnoid cyst managed in the Department of Neurosurgery, Banha University Hospital and in Al-Ahrar Teaching Hospital. All patients were operated by shunt insertion in 10 patients and microscopic fenestration into basal cistern with excision of the cyst wall in the other 10 patients. Results: The study included thirteen males and seven females with male predominance in 65% of the cases. The age of the patients in this study ranged from one month to 15 years. There are statistically non-significant differences between the studied groups regarding age, gender, operative time, follow-up time, stay in ICU or ward, total hospital stay, postoperative complications, outcome or need for reoperation. Conclusion: There is no actual difference between microscopic fenstration of arachnoid cyst and cystoperitoneal shunt.