<p>To evaluate the application and clinical outcomes of blood flow reconstruction techniques in the microsurgical management of skull base meningiomas involving critical vasculature, a retrospective analysis was conducted on 12 patients who underwent microsurgical tumor resection combined with vascular reconstruction between September 2016 and March 2025.Preoperative and postoperative imaging evaluations included contrast-enhanced magnetic resonance imaging (MRI), computed tomography angiography (CTA), and digital subtraction angiography (DSA). Of the 12 patients, 2 were newly diagnosed, while 10 had recurrent meningiomas following previous surgical interventions. Involvement of the internal carotid artery (ICA) by the tumor was classified as encasement (<i>n</i> = 4), displacement (<i>n</i> = 5), or luminal stenosis (<i>n</i> = 3). Vascular reconstruction was achieved through superficial temporal artery to middle cerebral artery (STA–MCA) bypass (<i>n</i> = 4), internal carotid artery–radial artery–middle cerebral artery bypass (<i>n</i> = 4), and petrous segment–radial artery(RA)–clinoidal segment bypass (<i>n</i> = 4). Intraoperative assessments and postoperative imaging confirmed satisfactory graft patency in all cases. Gross total resection (Simpson grade I) was achieved in every patient. During a mean follow-up period(19.2 ± 15.3 months), no evidence of tumor recurrence was observed. Blood Flow Reconstruction in skull base meningiomas with involvement of major vessels facilitates more complete tumor resection and mitigates the likelihood of postoperative residual tumor and recurrence.</p>