Objective To explore the microsurgical experience of supra- and infra-tentorial meningioma of the posterior petrous bone.Methods Clinical data of 21 patients who had undergone microsurgical treatment were retrospectively reviewed.Results All patients underwent surgical treatment via a suboccipital retrosigmoid approach,and hyperostosis of the petrous bone and infiltrated cerebellar tentorium were resected intraoperatively.Tumor resection was categorized as Grade Ⅰ in 16 patients,Grade Ⅱ in 5 patients,according to the Simpson classification system.The main postoperative complications included slight facial paresis and hearing function deterioration.The mean follow-up time was 3.2 years.All patients resumed normal daily activity and no tumor recurrence happened.Conclusions Total resection for supra- and infra-tentorial meningioma of the posterior petrous bone can be achieved with an excellent prognosis by use of microsurgical technique.