BACKGROUND: WHO Grade I meningiomas are common, usually benign, primary brain tumors. Little is known about the health-related quality of life (HRQOL) of patients with meningiomas. OBJECTIVE: To investigate the long-term HRQOL in patients with meningiomas and its association with cognitive deficits and epilepsy. METHODS: HRQOL was assessed by the Short-Form Health Survey questionnaire (SF-36) in 89 patients with WHO Grade I meningiomas at least 1 year following neurosurgery with or without radiotherapy. Cognitive functioning was measured by a neuropsychological test battery, and epileptic seizure frequency and antiepileptic drug (AED) use were determined for each patient. HRQOL of patients was compared to that of 89 healthy controls individually matched for age, sex, and educational level. RESULTS: As a group, patients with meningiomas did not differ from healthy controls on 7 out of 8 SF-36 scales; the only difference was that patients reported more role limitations caused by physical problems (P < .05). Patients with meningiomas had significant impairment in 4 of 6 cognitive domains, most pronounced in the domain of executive functioning. Both impaired cognitive functioning and AED use were associated with a compromised HRQOL. Of the 23 patients using AEDs, HRQOL was significantly impaired on 5 out of 8 SF-36 scales. In patients using AED, neither cognitive functioning nor HRQOL differed between those with and those without seizure control. CONCLUSION: The HRQOL of most patients with WHO Grade I meningiomas is comparable to that of the general population. However, HRQOL is worse in patients with major cognitive deficits and those using AEDs, irrespective of seizure control.