Atypical meningioma (AM) tends to be tumor with high rates of recurrence and mortality. In this retrospective study, 131 recurrent AM patients underwent AM surgery in Beijing Tiantan Hospital between January 2008 and December 2015. Of the 131 cases collected, 61 were male (46.6%), and 70 (53.4%) were female. 53 (40.5%) patients chose observation instead of therapy, 53 (40.5%) received repeat surgery and 25 patients (19.0%) received gamma knife surgery (GKS). The median overall survival (OS) was 34.6 months and actuarial OS of patients at 1, 3 and 5 years were 88.6%, 48.8%, 36.0%, respectively. In the treatment group including 78 patients with surgery and GKS group, a tumor progression happened to 35 patients (44.9%). The median duration of progression-free survival (PFS) was 34.5 months and the median OS was 61.7 months. Second PFS at 1, 3 and 5 years were 84.1%, 46.5% and 24.0%, respectively; the corresponding OS was 98.5%, 75.1%, 57.9%, respectively. Multivariate analysis revealed treatment strategy was the only independent factor (P < 0.001). In the treatment group, non-peritumoral edema (P = 0.002), preoperative KPS (per 10 scores increase) (P < 0.001) and GKS (P = 0.042) was related to better OS. Short interval (<24 months) from symptoms onset to intervention was related to better PFS (P = 0.004) in univariate analysis. This retrospective study presents the largest cohort of recurrent AM patients, surgical treatment is recommended in patients with tumor recurrence, and GKS is considered a promising therapeutic option of recurrence atypical meningioma. (C) 2019 Published by Elsevier Ltd.