Background: Atypical meningiomas differ from Grade I meningiomas in aspects of the higher rate of recurrence, more postoperative complications, and shorter life expectancy postoperatively. Objective: This study was aimed to evaluate the clinical course of atypical meningioma and prognostic factors affecting its surgical outcomes. Patients and Method: This retrospective study investigated the medical records of 45 patients who had surgical removal of atypical meningiomas at Benha University Hospitals between January 2010 and December 2021. Patients average age was (56.69± 11.11) ranged from 29 to 74 years. The follow-up period was 60 months. Analysis included multiple factors such as patient age, gender, tumor size, location, and the extent of surgical resection based on (Simpson Grading System). Results: There was significant relationship between recurrence and Simpson grade, size, and side. There was a significant relationship between rate of recurrence and type of radiation used. The mean survival time was significantly longer in Gamma knife group compared to radiotherapy. Rate of mortality was significantly higher in group radiotherapy compared to gamma knife with hazard ratio (95% CI) (5.33(0.79-36.75%). Rate of recurrence was significantly higher in group radiotherapy compared to gamma knife with hazard ratio (95% CI) (3.03(0.89-10.31%). Conclusion: It could be concluded that atypical meningiomas in elderly patients with a large size especially more than 60cc, incomplete surgical resection; frequently have poorer prognosis following surgical intervention. Postoperative radiotherapy could provide accepted local tumor control in patients with incompletely resected atypical meningioma.