Background: Posterior Fossa Dermoid Cysts (PFDCs), associated with a Dermal Sinus (DS), are rare congenital brain tumors. More rarely, PFDCs may complicate with cerebellar abscess or hydrocephalus. These complications are represented in only a few case reports as a separate entity. The Neurosurgical literature has a paucity of information regarding the management approach to PFDC when they complicate with both cerebellar abscess and acute obstructive hydrocephalus.