Background Atypical meningioma accounts for about 4.7% to 7.2% of all kinds of meningiomas,which is invasive with a relatively high recurrence and mortality. The objective of this study was to investigate the clinical manifestations and therapeutic strategies of atypical meningioma.Methods A total of 74 patients who underwent surgical treatment and pathologically confirmed for atypical meningioma in Neurosurgery Department of Beijing Tiantan Hospital from January 2003 to December 2008 were enrolled in this study.The characteristics of the tumors as well as therapeutic regimens and follow-up data were reviewed. After surgery,56patients underwent radiotherapy. Patients were followed up for about 3.5 years (range,0.5-6.0 years),and 58 patients completed follow-up.Results Of the 58 patients who completed follow-up,good recovery was found in 30,neurological dysfunction in 15,and death in 13. Of the 58 patients,21 had recurrent meningioma and 18 underwent a second surgery.Conclusions Atypical meningioma is difficult to manage,with a high recurrence rate and poor survival. The extent of tumor resection and histological grade are the key determinants of outcome. Radiation therapy can be used as an adjunctive treatment after total or partial resection.