EXTRA-AXIAL TUMORS of the cerebral convexity and midline include both convexity and parasagittal meningiomas; they are the most common tumors of the cranial vault and are the principal topic of this article. Over the past 30 years, neurosurgery has witnessed steady change in both technological capacity and in conceptualization of certain diseases. Meningiomas are good examples of this change. Although cranial base meningiomas have received the most attention in the past two decades, the management of cranial vault meningiomas has also changed significantly. Particular issues include decisions about when to treat, deciding between surgery and radiosurgery, increasing use of image-guided surgery, the understanding of the biology of these tumors, and changing attitudes in the management of the sagittal sinus. These issues exemplify the changing biological, conceptual, and technological concepts that characterize contemporary neurosurgery.