OBJECTIVE: To explore the value of multi-modal image fusion 3D reconstruction technology combined with 3D printed guide plates in meningioma surgery. METHODS: The clinical data of 16 patients with meningioma who underwent tumor resection at Taizhou People's Hospital between November 2022 and May 2024 were retrospectively analyzed. Preoperative thin-layer CT and MRI examinations were performed on all patients. Multi-modal image fusion and 3D reconstruction were performed on the CT and MRI data using the 3D Slicer software to create 3D models of the skin, muscle, skull, tumor, cerebrovascular structures, and other relevant anatomical features. These models were used to develop optimal surgical plans and design 3D guide plates. The 3D printing guide promoted precise localization of the tumor on the body surface, assisted in the design of the bone flap and scalp incision, and identified key surgical landmarks. General data, results of multi-modal image fusion 3D reconstruction, accuracy of the 3D printing guide, intraoperative data, surgical complications, and follow-up outcomes for all patients were summarized. RESULTS: The surgical approach was successfully planned, and 3D printed guide plates were created preoperatively based on the multi-modal image fusion and 3D reconstruction models. The 3D guides enabled precise body surface localization of the tumor and full exposure of the tumor and peritumoral tissue with the smallest possible bone window. Multi-modal image fusion 3D reconstruction images promoted the successful protection of important cerebrovascular structures and brain tissue during surgery. All 16 procedures were successfully completed, with the 3D reconstructed images closely matching the intraoperative observations. The tumor was accurately located beneath the incision and postoperative imaging confirmed complete lesion removal. CONCLUSION: Multi-modal image fusion combined with 3D printing guide technology provides precise localization for meningioma resection, aids in understanding the position of cerebrovascular structures and the skull, prevents deviations in the surgical pathway, optimizes the surgical process, predicts potential intraoperative challenges, increases the success rate of surgery, and decreases the rates of complications and recurrence.