en Skull Base Case report <div style="text-align: justify;"><strong>Background and Importance:</strong> Arachnoid cysts are developmental cystic lesions which may be&nbsp;found as an incidental finding on neuroimaging or present with symptoms of headache, seizure&nbsp;and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal</div> <div style="text-align: justify;">location. Presentation with Temporal Lobe Epilepsy (TLE) is rare, and fenestration of cysts has&nbsp;variable results for seizure control. We reported controlling TLE symptoms following endoscopic&nbsp;transsphenoidal fenestration of an arachnoid cyst. The anteromedial location in middle fossa,&nbsp;extension toward sphenoid sinus and normal appearance of mesial temporal structures on MRI&nbsp;encouraged us to consider this surgical approach.<br> <strong>Case Presentation:</strong> A 26-year-old patient with a 13-year history of TLE with uncontrolled&nbsp;symptoms despite taking a combination of AEDs (LTG, CBZ, LEV, CLB) was referred to our clinic.&nbsp;Neuroimaging revealed an arachnoid cyst in anteromedial part of temporal fossa which extended&nbsp;to sphenoid sinus, but showed no abnormality in mesial temporal structures. Endoscopic&nbsp;endonasal transsphenoidal fenestration of the arachnoid cyst was performed, and followed by reconstruction of the skull base. The procedure improved the seizure control during the 9-month follow-up and no sign of radiologic recurrence was observed.</div> <div style="text-align: justify;"><strong>Conclusion:</strong> Transsphenoidal endoscopic fenestration is a safe and feasible surgical approach for&nbsp;treatment of symptomatic arachnoid cysts in anteromedial part of middle fossa especially when&nbsp;they extend toward lateral wall of sphenoid sinus. This surgical corridor has the privilege of avoiding<br> cortical injury accompanied by transcranial approaches, which is deleterious in epileptic patients.</div> Temporal lobe epilepsy (TLE), Neuroendoscopy, Transsphenoidal, Arachnoid cyst 93 98 http://irjns.org/browse.php?a_code=A-10-214-2&slc_lang=en&sid=1 Arash Saffarian Saffarrian@yahoo.com 10031947532846004202 10031947532846004202 No Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Nima Derakhshan nima_med83@yahoo.com 10031947532846004203 10031947532846004203 Yes Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Mousa Taghipour taghipom@sums.ac.ir 10031947532846004204 10031947532846004204 No Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran Mohammad Faramarzi faramarzi@sums.ac.ir 10031947532846004205 10031947532846004205 No Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran Ali Akbar Asadipooya aliasadipooya@yahoo.com 10031947532846004206 10031947532846004206 No 1. Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2. Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Amirreza Dehghanian adehghan@sums.ac.ir 10031947532846004207 10031947532846004207 No Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran Keyvan Eghbal keivaneghbal@gmail.com 10031947532846004208 10031947532846004208 No Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran