Objective To evaluate the microsurgical treatment of anterior clinoidal meningiomas (ACMs) and the early visual acuity recovery in ACM patients after surgery. Methods A retrospective review was performed on 64 patients with ACMs who were microsurgically treated in the Department of Neurosurgery, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jul. 2010 to Jul. 2020. There were 19 (29.7%) males and 45 (70.3%) females with an average age of (52.3±12.2) years. Thirty-two (50.0%) cases had large ACMs (diameter＞4.0 cm), 27 (42.2%) cases had medium ACMs (diameter 2.0-4.0 cm), 5 (7.8%) cases had small ACMs (diameter＜2.0 cm), and 46 (71.9%) cases involved important neural and vascular structures. All patients underwent tumor resection via the pterional approach (extended pterional approach) or orbitozygomatic approach. The extent of tumor resection was evaluated by Simpson classification, the complications were calculated, and the recovery of visual acuity was assessed within 1 week after surgery. Results Among the 64 patients, 49 cases were surgically treated with the pterional approach (extended pterional approach), and 15 cases were treated with the orbitozygomatic approach. Simpson Ⅰ-Ⅱ resection was achieved in 52 (81.2%, 52/64) cases, Ⅲ in 8 (12.5%, 8/64) and Ⅳ in 4 (6.2%, 4/64). For typeⅠACMs, all 21 tumors had a hard texture, and 13 (61.9%, 13/21) were Simpson Ⅰ-Ⅱ resection; for type Ⅱ ACMs, 33 tumors had a soft texture, 6 tumors had a hard texture, and 35 (89.7%, 35/39) were Simpson Ⅰ-Ⅱ resection; and for type Ⅲ ACMs, 4 tumors had a soft texture, and 4 (100.0%, 4/4) were all Simpson Ⅰ-Ⅱ resection. The complications of early oculomotor nerve injury occurred in 6 (9.4%, 6/64) cases after surgery, cerebrospinal fluid leakage occurred in 2 (3.1%, 2/64) cases and death occurred in 1 (1.6%, 1/64) case. Of the 56 patients with preoperative headache and dizziness, 40 (71.4%, 40/56) cases were improved within 1 week after surgery; of the 29 patients with decreased preoperative visual acuity, 12 (41.4%, 12/29) cases had improved visual acuity within 1 week after surgery. Conclusion For some ACM patients with decreased visual acuity, their visual acuity is improved in the early postoperative period. For the tumors with soft texture, the rate of complete resection (Simpson Ⅰ-Ⅱ resection) is high and neural function recovers well. For the tumors with hard texture, complete resection is very difficult and may cause severe neurological complications.