Background: The classic-teaching craniotomy for the venous-sparing approach to a parasagittal meningioma (PSM) crosses the midline. This crossing might endanger the superior sagittal sinus (SSS) and the venous lacunae. Accordingly, some consultants employ the technique of not crossing the midline with the craniotomy in the venous-sparing approach for a unilateral PSM. Aim: This study aimed to assess the recurrence of parasagittal meningiomas after Simpson grade II excision through unilateral craniotomies not crossing the midline. Methods: The study retrospectively reviewed the medical records of patients who underwent surgical excision of a PSM at our university hospital from 2008 to 2016. The inclusion criteria were PSM that were Simpson Grade II excised through unilateral craniotomies without crossing the midline. We included 72 nonconsecutive cases. Results: The mean age of the included patients was 58.7 years. The mean follow-up period was 103.4 months. Thirty-one cases were followed for more than ten years. The performed craniotomies were uneventful. There was no reported incidence of any venous injuries. There was no operative mortality and no persistent neurologic deficit. The five-year recurrence rate was 4.1%. The ten-year recurrence rate among the thirty-one cases with long follow-ups was 16.1%. Conclusion: The recurrence rate of the parasagittal meningiomas excised through unilateral craniotomies not crossing the midline was comparable to that of other studies that performed craniotomies crossing the midline. The results indicated that it may be unnecessary to cross the midline with the craniotomy for the venous-sparing approach for a unilateral PSM.