Objective: Skull base meningiomas account for approximately 25% of intracranial meningiomas and pose significant therapeutic challenges due to their proximity to critical neurovascular structures. This study aims to review the management of vascular injuries during endoscopic endonasal approaches (EEA) for resecting meningiomas of the anterior and middle cranial fossa. Given the potential for severe morbidity and mortality resulting from vascular complications, this review focuses on identifying key anatomic landmarks, predisposing factors, and strategies for managing such injuries. It proposes a structured treatment algorithm and consolidates data on reported vascular injuries from existing literature, aiming to inform clinical practice and guide future research toward establishing validated treatment protocols and guidelines.