Arachnoid cysts of the sellar region are rare.(1-3 )When surgery is needed, it is usually performed through the endoscopic endonasal approach.(4-6 )However, some features of the cyst may suggest a transcranial route as a better alternative. We presented the case of a 28-year-old woman with a sellar and suprasellar arachnoid cyst, which displaced the pituitary gland and the optic chiasm cranially. By going through an endoscopic endonasal approach, the cyst could be easily opened; however, fenestration into the basal cisterns would be fairly limited and therefore increasing the risk of recurrence. Furthermore, pituitary function and cranial nerve integrity would be at risk. By going through a transcranial route, we circumvented these problems and were able to achieve wide fenestration into multiple basal cisterns.In7-9 this video, we discussed how the goal of surgery, the particular characteristics of the lesion, and anatomic features of the patient should dictate the surgical approach. The patient consented to the procedure and to the publication of her images.