Abstract: Objective The middle and posterior one-third segment of the superior sagittal sinus involves sensory and motor function areas and several important reflux veins. The article is to explore the surgical strategy of invasive parasagittal meningioma, so as to maximize the safety of patients.Methods A total of 99 patients who were admitted to Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University from April 2010 to April 2018 and diagnosed with invasive parasinus meningioma at the middle and posterior one-third of the superior sagittal sinus were selected and their clinical data were retrospectively analyzed. They were divided into two groups: group I, including 59 patients who underwent total tumor resection in the superior sagittal sinus under a microscope, and group II, including 40 patients who underwent tumor resection outside the superior sagittal sinus under a microscope (the sagittal sinus was not incised and the tumor inside the sinus were not treated), before treatment with γ knife. The independent risk factors for postoperative complications in groupⅠwere analyzed. Both groups were compared for the incidences of postoperative complications, 5-year recurrence rate after treatment, and the proportion of patients with excellent (>90 points) KPS score for the quality of life three months after treatment.Results Univariate analysis and multivariate logistic regression analysis showed that patients aged≥60 years, tumors located at the middle one-third segment of the superior sagittal sinus, tough tumor texture, more than three draining veins around the tumor were the independent risk factors of postoperative complications (P<0.05). The proportion of patients with excellent KPS scores three months after treatment was 64.4% for group I and 62.5% for group II, without statistical differences (P>0.05). The incidence of postoperative complications was 22.0% for group I and 7.5% for group II, which were statistically different (P<0.05). The 5-year recurrence rate was 10.16% for group 1 and 12.5% for group 2, without statistical difference (P>0.05).Conclusions Resection of intrasinus tumors through sagittal sinus incision requires advanced skills and shows certain risks. For patients aged ≥60 years, with tumors located at the middle one-third segment of the superior sagittal sinus and invading the sinus, with more than three veins around the tumor, and tough tumor texture, post-operative treatment of residual tumors in the superior sagittal sinus through γ knife or other radiotherapy, rather than during surgery, can also achieve satisfactory clinical outcomes.