OBJECTIVE: To investigate the method and efficacy of microsurgery in the treatment of anterior bed synostosis meningioma. METHODS: A retrospective analysis was performed on 53 patients with anterior bed synostosis meningioma admitted to Beijing Hospital from October 1991 to October 2009. There were 15 males and 38 females, aged 33 to 65.5 years, with an average of 45.5 years. Treatment was performed by surgical resection of the tumor using a trans-pterygoid point, expanded pterygoid point, orbitozygomatic, and frontal orbitozygomatic approach. RESULTS: Among the 53 patients, 5 cases were resected at grade I; 33 cases were resected at grade II; 2 cases were resected at grade IIIA; 2 cases were resected at grade IIIB; 6 cases were resected at grade IVA; 4 cases were resected at grade IVB; and 1 case was resected at grade V. The percentage of grade II or above was 71.7%, and the percentage of ⅣA and ⅣB was 18.9%. There were 48 cases of self-care; 4 cases of partial self-care; 1 case of self-care due to middle cerebral artery injury; no death cases. Conclusion: Most saddle node meningiomas can be safely and effectively resected by microsurgery; different surgical approaches are used according to tumor size and growth pattern; microsurgery can significantly improve the total tumor resection rate, reduce surgical complications, and decrease mortality; for tumors that invade important structures such as cavernous sinus and internal carotid artery and are left behind, postoperative radiation therapy is feasible.