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We retrospectively studied 18 pregnant women from 600 cases of meningioma treated at this Institution between 1986 and 2001. The variables evaluated included clinical presentation; radiological findings; timing and extent of surgical resection; and an overview of gestational, clinical, and surgical outcomes. Visual impairment was the chief complaint followed by headache and seizures. The tumors involved the tuberculum sella (8), sphenoid wing (4), convexity (2), parasellar (2), cerebellopontine angle (CPA) (1), and anterior falx (1). Gross total resection was achieved in 14, and subtotal resection was achieved in two patients. There were no related fetal or maternal deaths. Of seven patients with advanced or progressive visual impairment who underwent resection during pregnancy, three improved noticeably, two worsened, and two were unchanged. Five other patients with visual disturbance achieved full-term spontaneous delivery with improved vision in two and improved vision after post-confinement surgery in one. Vision remained unchanged in two. Intracranial meningioma during pregnancy challenges the skill of obstetricians and neurosurgeons to secure delivery of the baby and resection of the tumor. Advances in fetal and maternal monitoring, neuroanesthesia, and microsurgical techniques allow safe neurosurgical management of these patients, and pregnancy usually continues successfully to term. Surgical intervention has no major effect on minimal residual vision or advanced optic nerve atrophy.