OBJECTIVE: We retrospectively assessed the surgical outcomes of transitional meningioma (TM) in a relatively large series to evaluate the long-term outcomes and propose an appropriate treatment strategy for TM. METHODS: We included 298 patients who had undergone surgery from September 2011 to August 2013. The clinical characteristics, surgical record, and follow-up data for these patients were retrieved. RESULTS: The 298 enrolled patients included 213 women (71.5%). The mean and median age of the 298 patients was 50.7 +/- 0.6 years and 52.0 years (range, 6.0-74.0), respectively. Radiologically, 144 tumors (48.3%) were located in the skull base. Gross total resection (GTR) was achieved in 266 patients (89.3%); 7 patients (2.6%) received adjuvant radiotherapy. After a median follow-up of 61.8 months, 23 patients (8.6%) had developed recurrence and 2 patients (0.8%) had died. The results from univariate analysis indicated that GTR was associated with better progression-free survival (hazard ratio, 0.165; 95% confidence interval, 0.071-0.382; P < 0.001)1 Skull base tumors tended to predict for poor progression-free survival (hazard ratio, 2.169; 95% confidence interval, 0.919-5.118; P = 0.077). For the first tumor recurrence, 11 patients (47.8%) underwent gamma knife radiosurgery, and only 2 patients developed a second recurrence. CONCLUSION: The results from the present study have shown that GTR should be achieved during the first surgery for TM. Gamma knife radiosurgery might be an effective therapy for patients with tumor recurrence.