Pterygoid crest meningiomas (pterygoid spine meningiomas) are divided into lateral and medial types. Medial pterygoid crest meningiomas and anterior bed process meningiomas are sometimes difficult to distinguish and are often grouped together in a general way. The lateral type is relatively simple, and this article focuses on the medial type. Patients with pterygoid crest meningioma often have symptoms of visual field loss due to optic nerve compression prior to surgery, and the tumor may also be tightly adherent to the carotid artery, making surgery difficult and dangerous. Due to the obstruction of the optic nerve, carotid artery and skull, the tumor often burrows into the optic nerve canal, which makes total removal of the tumor difficult and often misses smaller tumors, and has a high probability of tumor recurrence. The main surgical principle is to grind away the pterygoid crest, anterior bed process and optic nerve canal as much as possible, i.e., the so-called DOLENC approach. The removal of the anterior bed process can open the optic nerve canal and facilitate the release of the full length of the free optic nerve, resect the tumor inside the optic nerve canal, and reduce the probability of recurrence; the pterygoid crest and anterior bed process do not play a significant role in the human body, and the removal of the pterygoid crest and anterior bed process can create a surgical space to protect the optic nerve, carotid artery and brain tissue, which is in line with the concept of minimally invasive surgery; although the surgical incision is not smaller, it is very much in line with the concept of minimally invasive surgery. Although the incision is not smaller, it is very much in line with the concept of minimally invasive surgery.