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Invasive meningiomas involving the medial sphenoid wing are difficult tumors to resect completely. They often have invaded the surrounding arteries at the time of diagnosis making total resection challenging. Attempts at removing these tumors from adherent carotid or middle cerebral arteries have resulted in high complication rates. Nine cases of medial sphenoid wing meningiomas with arterial invasion were operated between March 1994 and August 1998. Total resection was possible in only four cases. Two arterial-related complications occurred during resection with one resulting in permanent hemiplegia.