Tuberculous meningitis (TBM) is a non-suppurative meningeal inflammation caused by Mycobacterium tuberculosis (Mtb) infection, characterized by insidious onset, poor specificity in clinical manifestations and poor prognosis, making it the type of extrapulmonary tuberculosis with the highest mortality rate. The pathogenesis of TBM is complex and diverse, primarily resulting from insufficient primary immune response or secondary immune deficiency of the body, leading to Mtb penetration through the blood-brain barrier and dissemination. Due to the atypical early clinical symptoms and conventional test results, as well as the low sensitivity of Mtb culture, early diagnosis of TBM is difficult. Recent advances in clinical testing and treatment have greatly improved, automated real-time nucleic acid amplification detection for Mtb and Rifampicin resistance and high-throughput sequencing technologies have been widely adopted, immunological and multi-omics detection techniques continue to advance, and novel anti-tuberculosis drugs along with comprehensive treatment regimens are now in clinical use. These integrated diagnostic and therapeutic approaches have significantly improved the clinical confirmation rate of TBM while reducing the complications and sequelae. This article reviews the current advances in diagnosis, treatment and research of TBM.