Intracranial cyst is an abnormal cystic mass in the skull, which is also called “intracerebral cyst” or “brain cyst”, but it should be called “intracranial cyst” exactly. Most of them are found by imaging such as head CT or MRI, and a few of them are found accidentally during surgery. Before imaging examination, it is difficult to make a clear diagnosis of brain cyst only by clinical symptoms of patients, but the diagnosis can be confirmed by imaging examination. Some patients with brain cysts are asymptomatic, but more patients with brain cysts are symptomatic. Which cysts need treatment? How to treat them? Many neurosurgeons also do not have a good grasp of the indications for treatment of brain cysts. Therefore, it is important to know about brain cysts. Intracranial cysts can be classified according to their nature as arachnoid cysts, hyaline septal cysts, epithelioid cysts, cortical cysts, choroid plexus cysts, cysts of intestinal origin, and true neoplastic cysts (e.g., craniopharyngioma cysts, glioma cysts, and nerve sheath tumor cysts). Intracranial cysts can be located on the surface of the brain (convex surface of the brain, floor of the brain, longitudinal fissure of the brain, below the superior cerebellar canopy, lateral fissure pool, tegmental pool, etc.), within the brain parenchyma, and within the ventricles of the brain. The presence of intracranial cerebral cysts can produce occupational effects and compression of brain tissue, brain appendages, and cerebrospinal fluid circulation pathways, resulting in clinical neurological symptoms such as headache, nausea, vomiting, seizures, limb movement or sensory disturbances, speech disturbances, and symptoms of cranial nerve damage (visual disturbances, eye movement disturbances, diplopia, eyelid ptosis, facial numbness or pain, tinnitus, hearing disturbances, voice (hoarseness, choking and coughing, difficulty swallowing, etc.). Symptomatic intracranial cysts should mostly be treated surgically; while asymptomatic intracranial cysts, because conservative treatment is ineffective, the cysts will continue to increase in size and the blood vessels in the cyst wall can rupture due to minor trauma leading to fatal intracranial hematoma with serious consequences before the onset of symptoms; therefore, the current attitude towards the management of asymptomatic intracranial cysts is aggressive, especially in pediatric patients. Asymptomatic small intracranial cysts in adults can be followed and observed, and should be actively treated once they increase in size or develop corresponding symptoms. For intracranial cysts, drug therapy is ineffective. For patients for whom treatment is definite, only surgery is considered. Given the nature and location of common intracranial cysts, neuroendoscopic management is the most reasonable option for the vast majority of intracranial cysts. Because craniotomy is more invasive, has more complications, has a longer recovery time, and is more expensive; and the cysts that can be managed with shunt surgery have more long-term complications and lower long-term success rates. Therefore, for the treatment of brain cysts, neuroendoscopic techniques should be considered first for management.