Abstract
Anterior cranial fossa meningiomas constitute an important subset of skull base tumors, frequently presenting late due to their indolent growth and the capacity of the frontal lobes to accommodate large masses before neurological symptoms emerge. This review synthesizes current evidence regarding epidemiology, molecular biology, clinical features, diagnostic considerations, and modern management strategies for olfactory groove, planum sphenoidale, and tuberculum sellae meningiomas. We examine more than 150 published studies, integrating contemporary molecular insights—including NF2 and non-NF2 mutations (TRAF7, AKT1, KLF4, PIK3CA, SMO)—with evolving surgical approaches such as endoscopic endonasal surgery, keyhole craniotomies, and extended skull base techniques. We further evaluate visual and neurocognitive outcomes, complication profiles, recurrence predictors, and long-term prognosis. Anterior cranial fossa meningiomas, although often benign, present unique operative challenges due to involvement of the optic apparatus, olfactory structures, and major vascular systems. Gross total resection remains the standard of care but is increasingly complemented by tailored approaches based on radiological anatomy, tumor consistency, vascular encasement, and patient comorbidities. This review aims to provide neurosurgeons, skull base surgeons, and trainees with a comprehensive, evidence-based reference for best practices in managing anterior fossa meningiomas. 