Introduction <p>Treatment of clival and petroclival meningiomas remains one of the unresolved problems in contemporary neurosurgery. Studies on this topic are rare, and the objective of our research is to evaluate the current outcomes of endoscopic transnasal approaches in the surgical management of meningiomas of the clival region.</p> Objective of the study <p>This study presents a single-center experience with the endoscopic endonasal transsphenoidal transclival (posterior extended) approach for the resection of clival and petroclival meningiomas.</p> Materials and methods <p>Twenty consecutively treated with histologically confirmed clival and petroclival meningiomas underwent EEA surgery between 2012 and 2024 year. Tumor volume and neurovascular involvement were radiologically assessed. A binostril endoscopic transsphenoidal transclival approach was used with intraoperative Doppler ultrasonography and neuronavigation.</p> Results <p>Total resection was achieved in 2 cases (10%), subtotal resection in 5 cases (25%), and partial resection in 13 cases (65%). The most common complication was meningitis. Neurological complications were rare.</p> Conclusions <p>Considering the difficult location of these tumors, the endoscopic transnasal approach serves as an additional option alongside transcranial approaches in the planning of surgical treatment.</p>