Background: Colloid cysts are rare benign lesions of the third ventricle that can cause hydrocephalus and intracranial hypertension. Their primary treatment is surgical removal. Although open surgery presents the best opportunity for total resection of the cyst, there is no consensus regarding the optimal choice between the interhemispheric and the transcortical approaches. We aim to compare these two approaches in regard of the radicality of excision, the recurrence rate, and the surgical imprint. Methods: Retrospective cohort study on all patients who underwent surgical resection of colloid cyst between 2003 and 2023 at CHU de Québec. Data on demographics, symptoms, complications, and imaging was gathered. Results: In a cohort of 28 patients (17 interhemispheric, 11 transcortical), the preliminary results demonstrate prolonging operative time (270min. vs. 187min.) and increasing blood loss (193cc vs 100cc) associated with the interhemispheric approach. Despite these results, the hospitalization duration remains similar (p=0.734). However, the interhemispheric approach results in significantly lower surgery-induced encephalomalacia (1.1cc vs. 4.4cc, p=0.006). Conclusions: The interhemispheric approach could lead to potentially lesser consequences due to the reduced volume of encephalomalacia left by the surgical intervention, at the cost of prolonged operating time and higher blood loss.