Cystic meningiomas are uncommon tumors that are easily confused with metastatic or glial tumors that have cystic components. We have retrospectively reviewed all of the meningiomas operated on at the University of Puerto Rico in a 5-year period (1989-1993) and found only five cystic meningiomas (4.3% of total meningiomas). There is still debate about the etiology of the cyst wall; thus, multiple biopsies and frozen sections are recommended. Magnetic resonance imaging has improved diagnostic accuracy with its ability to demonstrate the dural attachment of the tumor.