OBJECTIVE: Because of the paucity of relevant data, treatment and outcomes in intracranial atypical meningioma (AM) remain unclear. The aim of this study was to find useful factors predicting survival and to evaluate the role of postoperative radiation after surgery. METHODS: Data were obtained from 302 patients with AM who underwent surgery between January 2008 and December 2015. RESULTS: A series of 302 patients, including 166 female and 136 male, underwent surgery at our institution. Gross total resection (GTR) was achieved in 201 (66.6%) patients. Seventy-five patients (24.8%) underwent postoperative radiation after surgery. For the entire cohort, there were 131 (43.4%) recurrences, 1 (0.33%) metastasis, and 56 (18.5%) mortalities during a median follow-up duration of 41.6 months. The median recurrence-free survival (RFS) was 55.2 months after the date of the first AM surgery, with 1-year, 3-year, and 5-year RFS rates of 87.6%, 63.3% and 47.7%, respectively. The median overall survival (OS) for patients was 99.8 months, and the actuarial OS rates from the time of the first AM surgery at 1, 3, and 5 years were 97.0%, 90.6%, and 78.8%, respectively. In multivariate analysis, preoperative Karnofsky Performance Scale score (>= 80), primary tumor, tumor invasiveness, and GTR were associated with increased RFS, whereas preoperative Karnofsky Performance Scale score (>= 80), primary tumor, supratentorial location, lack of peritumoral edema, radiotherapy, and GTR were associated with increased OS. CONCLUSIONS: GTR is the first choice for patients with AM. We recommend that patients with secondary tumors receive radiotherapy after surgery.