Background: Arachnoid cysts (ACs) are benign developmental cysts that occur along the craniospinal axis. Arachnoid cysts comprise 1% of all intracranial space-occupying lesions. Objective: To evaluate the cases of intracranial arachnoid cysts clinically and radiologically and the possibility of surgery. Patients and Methods: The study was done prospectively on 22 patients presented with intracranial arachnoidcysts (15 of them were medically managed, and 7 of them were surgically managed) in the Neurosurgery Department, Al-Azhar and Alexandria Universities on patients suffering from extra-axial intracranial arachnoid cysts. The study was performed through the period from March 2019 to February 2020, and the follow up period was 6 months. All cases, either surgical or conservative cases, had been evaluated regarding (clinical improvement of symptoms, radiological reduction in size of the cyst, rate of complications, wound healing and need for subsequent lines of management. Results: Patients with satisfactory clinical outcome was observed in most of the total managed cases (72.7%). There was a statistical significant difference in clinical outcome between the medical management group and the surgical management group as almost medically managed patients (86.7%) improved clinically. Improved radiological outcome was observed in 42.9% of surgically managed patients. Postoperative complications were observed in the majority of surgically managed patients. Most common complication was hydrocephalus in 42.9% of patients. Conclusion: Management of intracranial arachnoid cysts remained controversial, and most of the patients managed conservatively, but we believe that proper clinical and radiological evaluation of symptomatic arachnoid cysts leads to better outcome.