Objective To investigate the value and advantages of 4D-CTA combined with whole brain perfusion CTP technique by 320 row CT in preoperative evaluation of meningiomas adjacent to large vessels. Methods A total of 9 patients with suspected meningioma were examined by 320 row CT in whole brain perfusion volume scanning. Plain scan and multi-phase enhanced images can be obtained by one scan. By postprocessing, CTP images, blood vessels and perfusion or fusion images were obtained. After cutting, data information was extracted and reconstructed, then the size of tumor is simulated, and the tumor is extracted and fused with blood vessel. The size and shape of meningioma, the blood perfusion and its relation with adjacent vessels were observed and evaluated. Surgical plans were made for the surgeons by post-processing images. Results A total of 9 patients accepted the whole brain perfusion volume scan successfully. Abnormal perfusion areas were identified on 3D-CTP maps. Significant differences in CBF and CBV were detected between meningioma and normal brain tissues. The blood supplying and draining veins of the tumor could be observed on 4D-CTA images in 9 cases, and 6 patients underwent successful surgery, including 4 cases of fibrous meningioma and 2 cases of epithelial meningioma, while the other 3 patients had not undergone surgery. Conclusion 4D-CTA combined with CTP technology can reflect the meningioma blood supply accurately, can guide the surgeon to improve the operation plan effectively, which has great guiding significance for accurate resection of tumors and reduce intraoperative bleeding and injury.