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Colloid cysts are a rare clinical finding with a unique clinical presentation: non-specific paroxysmal headaches. The current recommended treatment is microsurgery, which poses the greatest risk to the patient but allows complete removal of the cyst to prevent recurrence. A 41-year old man presented with a colloid cyst located in the foramen of Monro causing obstructive hydrocephalus. He had paroxysmal headaches and memory and personality changes. Transcortical transventricle microsurgery was performed to remove the entire cyst. A temporary shunt was placed to prevent post-operative hydrocephalus. Normal neurological function returned upon cyst removal.