With the increasing availability and use of modern brain diagnostic imaging modalities, discovery of incidental meningiomas has become fairly common. This creates a dilemma among neurosurgeons as to whether these lesions should be treated. Numerous natural history studies have been published in an effort to shed light on the potential for growth of incidental meningiomas. The available data appear to suggest that these tumors can fall into 1 of 3 main growth patterns: no growth, linear growth, or exponential growth. The therapeutic strategy selected should also consider several other factors, mainly the risk of complications from an eventual surgery, the possibility of malignancies and other pathological conditions that mimic meningiomas, and the age and medical condition of the patient. The authors believe that most asymptomatic incidental meningiomas can be observed using serial imaging and clinical follow-up evaluations. Surgical interventions are typically reserved for large, symptomatic lesions and those with documented potential for significant growth.