In this study, we aimed to review the surgical outcomes of primary mediastinal cysts and to determine the differences among various histopathological types. We retrospectively analyzed the medical records of 41 patients with primary mediastinal cysts who underwent surgical excision. We found that despite advanced non-invasive diagnostic techniques, the definitive diagnosis of primary mediastinal cysts can only be made by interventional techniques. Surgery often provides curative therapy with low morbidity and mortality.