In this study, we explored the operation options for middle cranial fossa arachnoid cysts(MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y(mean=5.4 y). All these patients were divided into three subgroups according to Galassi classification.Long-term outcome and complications were studied respectively. Fenestration (F) resulted in a more favorable long-term outcome and less complication for cysts of types Ⅰ and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting (S). We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ (Galassi classification),cysto-peritoneal shunting is better for cysts of type Ⅲ.