Background: Meningiomas are common extra-axial primary brain tumors, which originate from the arachnoid cap cells. It's possible that intracranial meningiomas can be managed non-surgically. Objective: The aim of the current study was to evaluate non-surgical management of intracranial meningiomas to better guide the management decision-making. Patients and methods: A retrospective analytical study was conducted at the Department of Neurosurgery in the Faculty of Medicine at Zagazig University. A total of 53 patients, with 57 meningiomas were enrolled in the current study. Patients were divided into 2 groups based on symptomatic and radiological progression; Group A included 42 patients who continued non-surgical management, and Group B included 11 patients who required surgical intervention. Results: During the follow-up period, 19.3% of patients needed surgical intervention. The mean age of cases was of 54.1 (SD 9.7) years. Group A patients had significantly older ages at diagnosis than Group B patients (P<0.05). The tumor size in Group A was <25mm (64.4%), ranged from 25-40mm (35.6%), and >40 mm (0%) versus 25%, 66.7%, and 8.3%, respectively in Group B (P=0.014). Increased size at diagnosis was a significant predictor for surgical intervention (P<0.05). In Group A, the rate of growth/year was 1.94 (SD 0.74) mm with the range 0.22-3.94 mm/year versus 4.92 (SD 1.3) mm with the range 3.1-6.75 mm/year in Group B (P=0.0001). Conclusion: Our results contribute to predicting the growth pattern of intracranial meningioma and thus select the optimal management.