The patient presenting with a spinal meningioma usually has a slow indolent course of symptoms but at the time of diagnosis will have a range of neurological deficits. The diagnosis is most commonly secured with MR imaging. Safe resection of spinal meningiomas mandates a clear understanding of their growth characteristics as well as of regional anatomy. Surgical treatment of spinal meningiomas is gratifying, and the severity of preoperative neurological deficits should never deter one from withholding therapy.