At present, meningiomas originating from the saddle node, septum and pterygoid platform with anatomical range up to 3cm in diameter are still referred to as suprasellar meningiomas in clinical and imaging practice. Meningioma of the saddle septum is a meningioma that grows from the arachnoid granules of the saddle septum, which is rare and only 25 cases have been reported in China. In the past, there was a lack of understanding of septal meningioma in imaging, and it was easily misdiagnosed as pituitary tumor, so neurosurgery mostly used transoral, nasal and butterfly sinus access to the saddle base to perform saddle tumor resection. Since the meningioma is located above the pituitary gland, it is difficult to remove the tumor through this approach, and it is often unavoidable to damage the pituitary gland, and it is difficult to remove the tumor completely, and it is easy to leave the tumor tissue, and it is easy to recur after surgery. CT and MRI can clearly show the intracranial anatomy and provide accurate information on the location, extent of invasion and adjacent relationship of the lesion. In the past, the generalization of saddle septal meningioma as suprasellar or saddle node meningioma is obviously inappropriate. Therefore, it is important to adopt the diagnostic name of saddle septal meningioma for neurosurgery to improve the cure rate of saddle septal meningioma and to reduce the complications of surgery. The CT and MRI diagnosis of meningioma in saddle septum is that the tumor grows to the saddle and presses the pituitary gland or grows to the saddle and the side of the saddle, it is difficult to distinguish the tumor from the pituitary gland and other anatomical structures in CT, so it is easy to be misdiagnosed as pituitary tumor, etc. In MRI examination, the meningioma in saddle septum grows to the saddle and presses the pituitary gland and flattens it, and the tumor signal is similar to pituitary tumor and other tumors, so it is also easy to be misdiagnosed as pituitary tumor. Meningioma should be considered if there are the following manifestations: CT shows a round or slightly homogeneous slightly high-density or isodense shadow in the saddle, which may be accompanied by calcification, and enhancement is obvious; MRI shows a round or round-like shadow above the normal pituitary gland in the coronal or sagittal plane, with a more homogeneous isosignal on T1WI, enhancement is obvious, and the margin is clear, and a slightly homogeneous high-signal area on T2WI; clinically, combined with The MRI shows normal pituitary gland with homogeneous round-like signal in the coronal or sagittal plane, similar to the brainstem, with the pituitary stalk visible and the posterior part of the pituitary gland showing dotted fat signal as the characteristic performance. CT is not as valuable as MRI, and it is difficult to distinguish septal meningioma from pituitary gland, but CT is superior to MRI in showing meningioma with calcification. However, CT is better than MRI in showing meningioma with calcification. (1) Pituitary adenoma: CT shows a round-like or dumbbell-shaped mass growing from the saddle to the suprasaddle and parsaddle, with homogeneous or slightly homogeneous isointense or slightly high-density shadow, and obvious enhancement; MRI T1WI shows isosignal or mixed signal, T2WI shows mixed signal or inhomogeneous high signal. The diagnosis of pituitary adenoma is not difficult because pituitary adenoma is often accompanied by tissue necrosis and cystic changes, showing long T1 and long T2 signals, combined with the pterygoid saddle X-ray plain film, such as pterygoid saddle enlargement, saddle subluxation, anterior and posterior bed protrusion upward and the bone becomes sharp and thin. (2) Craniopharyngioma: CT shows a round or round-like cystic low-density area with eggshell calcification on the wall of the saddle or protruding into the third ventricle. However, for craniopharyngioma with equal or high density, it is difficult to differentiate it from saddle septal meningioma by CT alone. Because the tumor contents of craniopharyngioma contain cholesterol keratin, protein, orthohemoglobin, calcification, etc., it shows mixed signal (low signal mixed with high signal) or inhomogeneous low signal on T1WI; inhomogeneous high signal or mixed signal on T2WI; combined with the patient’s endocrine disorder and other manifestations, the diagnosis of most craniopharyngioma is not difficult. The diagnosis is not difficult.