Abstract: Objective: To improve the curative effect of microsurgery for parasagittal meningiomas. Methods: A retrospective analysis was performed on the clinical data of 29 cases of parasagittal meningioma. For our surgical decision-making, meningiomas were classified into six types according to the degree of sinus invasion as follows. Type Ⅰ: meningioma attached to outer surface of the sinus wall; Type Ⅱ: one lateral recess invaded; Type Ⅲ: one lateral wall invaded; Type Ⅳ: one lateral wall and the roof of the sinus both invaded; Types Ⅴ and VI: sinus totally occluded, one wall being free of tumor in type Ⅴ. In brief, our surgical manipulation was the following: Type Ⅰ: excision of outer layer and coagulation of dural attachment; Type Ⅱ: removal of intraluminal fragment through the recess and repair of the dural defect by resuturing recess; Type Ⅲ and Ⅳ: resection of both invaded walls and reconstruction of the resected walls with patch. The excision or vascular anastomosis reconstruction was carried out cautiously. Type Ⅴ and Ⅵ: According to the DSA, MRV and intraoperative evaluation, the nonfunctioning SSS would be excised without restoration with venous bypass. Otherwise, after a total resection, vasotransplantation is needed for reconstruction of the SSS. Results: Simpson Grade I resection was achieved in 23(79.3%) cases, Grade Ⅱ in 4(13.8%) cases and Grade Ⅲ in 2 (6.7%) cases. No patient died after surgery. Eight patients with normal preoperative activity presented with an early postoperative progressive hemiplasia, and only one still suffered unilateral paralysis of the upper extremities. All patients were followed up for 3 to 6 years. Only one patient suffered a recurrence 3.5 years after the surgical operation and received γ-knife stereotactic radiotherapy. Conclusion: Application of microsurgical techniques, protection of the sagittal sinus, avoidance of damage to the cerebral cortex and veins of central sulcus as well as other draining veins and venous flow restoration are important factors that increase the success rate of surgical resection, reduce complications and improve survival outcome in patients with parasagittal meningiomas.