OBJECTIVE To determine long-term (>10 years) visual outcome in patients with suprasellar meningiomas. METHODS Retrospective case series.RESULTS Among 18 patients who underwent surgery for suprasellar meningioma (1 patient died postoperatively), 1 experienced initial improvement in vision in both eyes, 8 experienced improvement in vision in one eye and maintained stable vision in the other eye, 2 experienced improvement in vision in one eye and worsening of vision in the other, 3 experienced worsening of vision in one eye and stable vision in one eye, and 4 maintained stable visual acuity in both eyes. No patient experienced postoperative worsening of vision in both eyes. During 10 years or more of follow-up, 10 of the patients (56%) maintained stable vision in both eyes, 6 patients (33%) experienced loss of vision in one eye while maintaining stable vision in the other, and 2 patients (11%) experienced loss of vision in both eyes. During this period, 7 of the 18 patients (39%) developed neuroimaging evidence of tumor growth or recurrence, with a mean time of 10.7 years. Four of these patients were thought to have had gross total resection of their tumor. Patients who experienced worsening of vision during the follow-up period were more likely to have developed neuroimaging evidence of growth or recurrence (five patients) than patients without such evidence (two patients), and such patients did not regain vision following subsequent surgery or radiation therapy. Nevertheless, at final examination, 13 patients (72%) had visual acuity of 20/40 or better in at least one eye. CONCLUSIONS The long-term visual prognosis for patients who undergo surgery for suprasellar meningioma is excellent, although tumor recurrence is common, even in patients thought to have undergone gross total removal of their tumor, and often occurs more than 10 years after surgery. Patients who develop tumor recurrence are likely to lose vision in at least one eye and are unlikely to achieve improvement in vision with subsequent surgery or radiation therapy. Thus, patients with suprasellar meningiomas believed to have been completely resected should undergo long-term, serial postoperative clinical examinations and neuroimaging to allow detection and further treatment of recurrences as early as possible. Postoperative radiation therapy should be considered for patients whose suprasellar meningiomas have been incompletely resected.