OBJECTIVE: Intracranial atypical meningiomas have a greater rate of recurrence than benign meningiomas. Scant literature, however, is available regarding the treatment and prognosis of these tumors after recurrence. The objective of this study was to analyze the treatment outcomes and prognostic factors of atypical meningiomas after recurrence of disease. METHODS: Forty-one cases with clinical characteristics and follow-up data were available in our department from 2000 to 2013. Certain factors, such as sex, age, preoperative Karnofsky Performance Status Scale score, location, prerecurrence tumor precursor, interval time, Simpson grade, histologic grade after recurrence, and radiotherapy, were selected to study the relationship with the prognosis of the tumors. RESULTS: The mean progression-free survival (PFS) and overall survival (OS) in our cases were 40.5 +/- 4.7 and 57.1 +/- 5.8 months, respectively. The 1-, 3-, and 5-year PFS rates were 79.8%, 44.1%, and 39.2%, respectively, and the corresponding OS rates were 92.4%, 66.1%, and 48.8%, respectively. The precursors of recurrent tumors were transformed meningiomas, an interval time less than 24 months, and a postrecurrence histologic diagnosis of anaplastic meningioma might predict an unfavorable outcome. Surgery Simpson I and II can improve the PFS and OS of tumors. Because of the limited number of cases, we could not identify a relationship between radiotherapy and prognosis. CONCLUSIONS: Recurrent atypical meningiomas are intractable tumors with a high rate of recurrence and death. Total resection of the tumors under relatively safe conditions remains the most suitable treatment strategy.