Meningiomas may influence both survival and neurological functions. Studies assessing the impact of surgery on health-related quality of life (HRQL) remain absent. In this prospective study we aimed to describe HRQL dynamics before and after surgery in patients with meningiomas. HRQL assessments were performed using EuroQol-5D (EQ-5D), a generic HRQL instrument. All adult patients with suspected intracranial meningioma from 2007 through 2011 were eligible for inclusion, and 54 patients were included after informed consent. All patients received a histopathological diagnosis of meningioma. The average preoperative EQ-5D index value (±SD) was 0.69 ± 0.26. The mean improvement 6 weeks after surgery was 0.06 (95 % CI, -0.03 to 0.16; p = 0.161) and the mean long term improvement was 0.09 (95 % CI, 0.00-0.17; p = 0.040). Surgery reduced pain/discomfort and anxiety/depression and improved the capability of performing usual activities. Clinically significant improvement at long-term assessment was noted in 25 patients (49 %) while a significant deterioration was reported in 10 patients (20 %). Patients who reported postoperative worsening of HRQL were also reporting better preoperative scores, suggesting a possible ceiling effect of EQ-5D in some of these patients. In our patients a modest average improvement in HRQL was seen after surgery for meningioma. About half of the patients reported a clinical important improvement at the late follow-up assessment. This improvement was mainly observed in the domains usual activities, pain/discomfort and anxiety/depression. However, one in five patients fared worse on late follow-up assessment, a figure of particular importance when treating asymptomatic meningiomas.