Objective To investigate the microsurgical skills for medial sphenoid ridge meningiomas and its therapeutic efficacy.Methods A retrospective analysis was performed on the clinical data of 26 patients with medial sphenoid ridge meningiomas who underwent microsurgery in our hospital from June 2013 to June 2017.Results All patients underwent microsurgical resection via the pterional approach or extended pterional approach. The advanced cases were surgically treated under electro-physiological monitoring. Of the 26 patients, 5 had Simpson grade I resection, and 21 had Simpson grade Ⅱ resection. No mortality was observed. After 6-48 months of follow-up, they had a good prognosis and no recurrence was observed.Conclusions Sophisticated microsurgery can effectively protect the peripheral nerves and blood vessels, increase the rate of total tumor resection, improve the therapeutic efficacy, and reduce tumor recurrence.