Meningiomas are benign tumors that grow slowly and have a long course. It has been reported that meningiomas present with early symptoms for an average of 2.5 years and up to 6 years in a few patients. Patients often present with headaches and seizures as the first symptoms. Depending on the location of the tumor, visual field, olfactory or auditory disturbances and limb movement disorders may also occur. In elderly patients, epileptic seizures are especially common as the first symptom. The symptoms of increased intracranial pressure are not obvious, especially in elderly patients. With the increasing popularity of CT examinations, many patients have only mild headache, or even meningioma detected incidentally by CT scan. Because of the slow growth of the tumor, the tumor often grows very large while the clinical symptoms are not yet severe. Sometimes patients have severe fundus optic papillary edema or even secondary optic nerve atrophy, while the headache is not severe and there is no vomiting. It is worth noting that when the tumor in the mute area grows very large and the brain tissue can no longer compensate for it, the patient only shows the manifestation of increased intracranial pressure, and the condition will suddenly deteriorate, and even brain herniation and death will occur in a short period of time. Diagnosis of meningioma: (1) Morphology, i.e. the shape and location of the tumor and its occupational effect. (2) The density of the tumor in CT and the signal intensity in MRI, and its performance after enhancement. (3) Other findings, such as skull involvement, calcification, vascular dilatation and compression, and confirmation of the blood supplying arteries and draining veins. The image of MRI is clearer than CT in meningiomas at the skull base, saddle area and pterygoid crest, or meningiomas with extracranial collaterals. MRI is also superior to CT in showing the proximity of tumors to important vessels. CT cranial scan: A typical meningioma, on an unenhanced CT scan, appears as an isolated isointense or dense occupying lesion. The density is uniform with well-defined margins, and calcifications are visible within the tumor. Enhancement reveals marked enhancement of the tumor, although a portion of the tumor does not appear vascular-rich on cerebral angiography. This is because the contrast agent enters the brain tissue directly from the capillaries surrounding the meningioma and there is no blood-brain barrier between the two. Approximately 15% of meningiomas are associated with atypical necrosis, cystic degeneration, or intratumoral hemorrhage. Brain edema around the tumor is helpful in determining the growth rate of the tumor. In slow-growing tumors, edema may be mild or even absent, and edema around vascular-rich meningiomas tends to be more extensive. Occasionally, meningiomas are surrounded by large combined edema, which needs to be differentiated from malignant meningioma or metastatic brain cancer. Magnetic resonance imaging (MRI): It is best to perform both CT and MRI on the same patient to obtain a more correct qualitative diagnosis. This is because meningiomas have similar presentation and characteristics in both images, and because MRI without enhancement can render 10% of meningiomas undiagnosed. Some meningiomas are not detected by MRI: (1) small asymptomatic meningiomas without combined edema and occupying effects, especially near the top; (2) multiple meningiomas that tend to be missed as small tumors; and (3) recurrent meningiomas. With contrast injection, the above disadvantages can be overcome. Surgical resection: As with other intracranial tumors, surgical resection of meningioma is the most effective treatment. Radiation therapy: Complete excision of benign meningiomas is excellent, but because of their growth location, about 17-50% of meningiomas cannot be completely excised. In addition, there are a few malignant meningiomas that cannot be fully resected. Both of these cases require radiation therapy after surgical excision. Malignant meningiomas and vascular ependymal meningiomas are sensitive to radiotherapy and the results are positive. In contrast, there is still disagreement as to whether radiotherapy is effective for benign tumors in general. Recurrence of meningioma As with any tumor, recurrence of meningioma may occur if some tumor remains in the primary site after the first surgery. There are two reasons for recurrence, one is localized tumor invasion. The second is the presence of more or less residual tumor cells close to the primary site. The literature reports that benign meningiomas take 5-10 years to recur, whereas tumors that grow locally invasive may recur in less than a year. The first choice in the management of recurrent meningiomas remains surgical resection. Depending on the patient’s signs and symptoms and CT analysis, the decision to reoperate may be made. The risk of reoperation depends not only on the age of the patient, but also on the general status of the patient and the location of the tumor. Secondary surgery is not always curative.