Meningioma of the lateral 1/3 of the pterygoid crest is a late onset of symptoms. It occurs in the large wing of the pterygoid bone and causes bone growth in the posterior lateral wall of the orbit and the temporal area, resulting in orbital shrinkage, or the tumor invades directly into the orbit and causes the eye to protrude. How to effectively prevent orbital shrinkage? Surgical excision of lateral pterygoid crest meningioma is not difficult, and postoperative recurrence and neurological impairment are rare. Medial meningiomas are more difficult to remove completely, and postoperative neurological impairment may occur in III, IV, and VI brains. Other patients may have postoperative limb movement disorders and motor aphasia. For patients with medial meningioma that cannot be completely resected, postoperative radiotherapy can be used to prevent recurrence. If the tumor recurs, reoperative resection can be considered. Total excision of pterygoid crest meningioma without compromising the patient’s neurological function is not an easy task. Medial meningiomas are particularly difficult because of the potential for invasion of the cavernous sinus and internal carotid artery. For both medial and lateral types, a frontotemporal approach centered on the pterygoid point is currently used. For tumors larger than 2. 0 cm in diameter, do not attempt complete resection of the tumor to avoid damaging important vascular and neural tissues. Special care should be taken when separating the adhesions between the tumor and middle cerebral artery. Any branch of middle cerebral artery should be carefully separated from the tumor wall, if it is really difficult to separate, part of the tumor wall adhering to the artery can be left behind, and try not to damage the middle cerebral artery and its branches to avoid serious consequences after surgery. The medial type tumor is deep to the internal carotid artery and optic nerve. In most cases, the tumor grows spherically and pushes the internal carotid artery inward, and in a few cases, the internal carotid artery is wrapped by the tumor. In the former case, the tumor is separated from the internal carotid artery and optic nerve by a layer of arachnoid membrane. In the former case, the tumor is separated from the internal carotid artery and optic nerve by a layer of arachnoid membrane. If there is really difficulty, it should not be forced. However, if the tumor encapsulates the internal carotid artery, the internal carotid artery may be narrowed in a circular pattern or even occluded, so it is difficult to remove the tumor around the intracranial artery. The tumor that invades the cavernous sinus can be completely resected in recent years. When separating the tumor, attention should be paid to identify and protect the III, IV and VI cerebral nerves. For bleeding from the cavernous sinus, absorbent gelatin sponge (gelatin sponge), hemostatic gauze, muscle and other materials can be used to stop the bleeding by compression.