Research on cognitive outcomes in meningioma patients has highlighted the complex interplay between psychological factors and cognitive performance. A study examining cognitive functioning in a large cohort of meningioma patients found that pre-surgical depression negatively correlated with cognitive performance, while anxiety did not show a similar relationship (ref: Rijnen doi.org/10.1093/neuonc/). This suggests that mental health may play a significant role in cognitive recovery post-surgery. Additionally, the study identified various predictors of cognitive functioning after surgery, emphasizing the need for comprehensive pre-operative assessments. In the context of clinical trials, challenges in conveying clinical equipoise and understanding patient treatment preferences were also noted, indicating that effective communication can enhance patient recruitment and informed consent in neuro-oncology trials (ref: Sherratt doi.org/10.1634/theoncologist.2019-0571/). Furthermore, variations in screening practices for asymptomatic meningiomas among childhood and young adult cancer survivors were documented, revealing that factors such as growth pattern, location, and size significantly influence management decisions (ref: Verbruggen doi.org/10.1007/s11060-020-03436-5/). These findings underscore the importance of personalized patient management strategies in improving cognitive outcomes and treatment experiences for meningioma patients.

The diagnosis and prognosis of meningiomas have been advanced through innovative methodologies and the integration of genetic insights. A study utilizing the Surveillance, Epidemiology, and End Results database developed a predictive model for individual patient outcomes, highlighting the overlap in clinical features of benign and malignant meningiomas (ref: Moreau doi.org/10.1038/s41746-020-0219-5/). Additionally, a distinct pattern of tumor infarction in grade I meningiomas was identified, which could mimic anaplasia, complicating diagnosis despite patients remaining free of progression post-resection (ref: Bale doi.org/10.1038/s41379-020-0491-6/). The genetic landscape of meningiomas was further explored through a rapid genotyping method that categorized tumors based on non-NF2 mutations, shedding light on the tumor microenvironment's role in tumorigenesis (ref: Adams doi.org/10.3390/ijms21041273/). Imaging studies have also played a critical role in differentiating skull vault tumors, emphasizing the need for radiologists to be familiar with the unique presentations of meningiomas to avoid misdiagnosis (ref: Pons Escoda doi.org/10.1186/s13244-019-0820-9/). These advancements collectively enhance the diagnostic accuracy and prognostic capabilities for meningioma patients.

Surgical techniques for meningiomas have evolved significantly, with studies comparing various approaches to optimize patient outcomes. A multicenter analysis of surgical outcomes for anterior cerebellopontine angle meningiomas revealed that the anterior transpetrosal approach had a significantly lower complication rate compared to the lateral suboccipital approach, although the tumor removal rates were comparable (ref: Hassaan doi.org/10.1007/s00701-020-04236-6/). Furthermore, a comparative study on the midline and paramedian supracerebellar infratentorial approaches indicated that the paramedian approach resulted in fewer postoperative complications and was achieved in a shorter operative time (ref: Choque-Velasquez doi.org/10.1016/j.wneu.2020.01.137/). Additionally, the endoscopic transorbital approach for sphenoid wing meningiomas demonstrated promising results, achieving high rates of Simpson resection grades I/II, comparable to traditional methods (ref: Park doi.org/10.1016/j.wneu.2020.01.115/). These findings highlight the importance of technique selection in minimizing complications and improving surgical outcomes for meningioma patients.

Radiotherapy remains a critical component in the management of meningiomas, with recent studies exploring its efficacy and associated risks. One study investigated the role of skull osteoporosis in the development of peritumoral brain edema following LINAC-based radiation treatment, finding that osteoporotic conditions could be a predictive factor for edema occurrence (ref: Lee doi.org/10.1371/journal.pone.0226312/). Long-term outcomes of multimodality management for parasagittal meningiomas indicated that gross total resection (GTR) significantly improved progression-free survival for grade I tumors, while adjuvant radiotherapy was beneficial for high-grade tumors (ref: Hua doi.org/10.1007/s11060-020-03440-9/). A prospective trial on multisession radiosurgery for large intracranial meningiomas aims to establish safety and efficacy, marking a novel approach in treatment protocols (ref: Pinzi doi.org/10.1186/s13014-020-1478-7/). Additionally, a study evaluating recurrence patterns post-gamma knife radiosurgery highlighted the importance of tumor size as a risk factor for progression, underscoring the need for careful monitoring post-treatment (ref: Nakazaki doi.org/10.1016/j.jocn.2020.02.019/). These insights contribute to a more nuanced understanding of radiotherapy's role in meningioma management.

Recent advancements in genetic and molecular research have provided deeper insights into the pathogenesis of meningiomas. The identification of ARMC5 as a tumor suppressor gene has significant implications for hereditary adrenocortical tumors and meningiomas, suggesting a potential target for therapeutic intervention (ref: Cavalcante doi.org/10.1530/ERC-19-0502/). A multi-center survey in Korea assessed the integration of molecular testing in CNS tumor diagnosis, revealing variability in practices and highlighting the need for standardized protocols to enhance diagnostic accuracy (ref: Cha doi.org/10.4132/jptm.2020.02.04/). Additionally, the expression of MIR17HG protein was found to be significantly elevated in meningioma tissues compared to controls, indicating its potential as a therapeutic target (ref: Evran doi.org/10.1016/j.wneu.2020.02.039/). These findings emphasize the importance of genetic profiling in understanding tumor behavior and developing targeted therapies for meningiomas.

The treatment of meningiomas presents various clinical challenges and ethical considerations, particularly with the integration of artificial intelligence in healthcare. A qualitative study revealed that patients, caregivers, and healthcare providers have differing perspectives on the ethical implications of using AI in health research, with a consensus on the need for transparency and the prohibition of selling health data (ref: McCradden doi.org/10.9778/cmajo.20190151/). Additionally, the use of acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following endoscopic approaches was explored, highlighting its potential to reduce recovery time and complications associated with harvesting autologous tissue (ref: Youngerman doi.org/10.1007/s00701-019-04200-z/). Furthermore, advancements in automated segmentation techniques for meningioma MRI have shown comparable effectiveness to manual methods, suggesting a shift towards more efficient diagnostic processes (ref: Laukamp doi.org/10.1007/s00062-020-00884-4/). These studies underscore the importance of addressing ethical concerns while advancing clinical practices in meningioma treatment.

Understanding the natural history of meningiomas is crucial for determining appropriate management strategies, particularly for asymptomatic cases. A meta-analysis revealed that while observation is common for asymptomatic meningiomas, it may increase risks associated with treatment due to potential tumor enlargement and patient aging (ref: Nakasu doi.org/10.2176/nmc.ra.2019-0213/). A case-control study indicated that asymptomatic patients undergoing surgery had a higher complication rate compared to symptomatic controls, particularly among older individuals, suggesting that careful consideration is needed when deciding on surgical intervention for asymptomatic cases (ref: Näslund doi.org/10.1007/s00701-020-04244-6/). Additionally, a retrospective review of infratentorial meningiomas in a developing country highlighted the need for more data on surgical approaches and outcomes, emphasizing the importance of understanding local contexts in treatment decisions (ref: Elkady doi.org/10.1016/j.wneu.2020.01.202/). These insights contribute to a more comprehensive understanding of meningioma management and the implications of observation versus intervention.