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Olfactory groove meningioma extending into the paranasal sinuses and nasal cavities is unusual. On rare occasions, it presents in the nasal cavity as a polypoid mass with ENT symptoms. We have experienced a case of meningioma presenting as a nasal polyp, in which the only clinical symptom was the sensation of having a foreign body in the left nasal cavity. The patient underwent polypectomy at a local clinic without radiologic evaluation, but because the polyp seemed to have originated from the nasal roof the patient was referred to our hospital. Magnetic resonance imaging (MRI) revealed an extensive intracranial tumor with extracranial extensions into the ethmoid sinuses and nasal cavities, and the tumor was confirmed as meningioma by histological and immunohistochemical examination. The tumor was removed by a transcranial route, and the cranial base defect was repaired with various nasal mucosal flaps and with abdominal fat via an intranasal endoscopic approach. After 8 months of treatment, no evidence of recurrence or of mucosal defect was noted. (Korean J Otolaryngol 2006;49:93-7)