Occipital pool cysts are the most common type of benign brain cysts. Occipital pool cysts are located in the posterior cranial fossa behind the cerebellum, which is a physiologic cavity that can be enlarged more than normal in some patients, with arachnoid-formed cystic walls and containing cerebrospinal fluid cysts, which are called occipital pool arachnoid cysts. This is a physiologic developmental abnormality that is detected during imaging tests such as cranial CT or magnetic resonance imaging. The vast majority of patients have no clinical symptoms and no specific treatment, as long as the cyst is regularly reviewed for changes and enlargement. In a very small number of patients, the cysts may increase dynamically, affecting the surrounding tissues and causing compression symptoms, such as dizziness, unsteady walking, ataxia, and other cerebellar symptoms. Surgery should be considered for treatment, and cystoperitoneal shunt surgery or endoscopic minimally invasive cysto-pelvic fistulas can be chosen.