Recent studies have focused on advanced imaging techniques and biomarkers to enhance the understanding and management of meningiomas. One significant study evaluated the use of 18F-FLT PET imaging as a predictor of tumor progression in asymptomatic meningiomas, revealing a positive correlation between tumor growth rates and 18F-FLT uptake (r < 0.513, P < 0.015), suggesting its potential as a non-invasive biomarker for monitoring tumor behavior (ref: Bashir doi.org/10.1093/brain/). Another study investigated the role of soluble PD-L1 as a systemic inflammation marker in patients with various brain tumors, including meningiomas, highlighting its association with local and systemic inflammation (ref: Mair doi.org/10.1136/esmoopen-2020-000863/). Furthermore, an integrated analysis of transcriptomic and proteomic data provided insights into the molecular landscape of meningiomas, identifying potential biomarkers for aggressive forms of the disease (ref: Dunn doi.org/10.3390/cancers12113270/). Techniques such as superselective pseudocontinuous arterial spin labeling (ss-pCASL) have shown promise in predicting tumor blood supply and embolization feasibility, with high interobserver agreement (κ = 0.817) (ref: Yoo doi.org/10.3171/2020.7.JNS201915/). Additionally, the use of apparent diffusion coefficient maps derived from diffusion-weighted imaging has been proposed as a method to predict the consistency of meningiomas, achieving a positive predictive value of 81% for detecting soft tumors (ref: Miyoshi doi.org/10.3171/2020.6.JNS20740/). Lastly, a radiomics model developed to predict histopathological grading based on MRI has the potential to enhance preoperative decision-making (ref: Han doi.org/10.1016/j.mri.2020.11.009/).

The surgical management of meningiomas has evolved with various techniques aimed at optimizing outcomes and minimizing complications. A systematic review and meta-analysis comparing unilateral and bilateral approaches for olfactory groove meningiomas found that both methods achieved gross total resection rates exceeding 90%, with similar complication rates, although meningitis and mortality rates differed significantly (ref: Feng doi.org/10.3389/fonc.2020.560706/). In a cohort of 162 patients with small cerebellopontine angle meningiomas, surgical outcomes were analyzed, revealing that the extent of resection significantly influences patient prognosis (ref: Bu doi.org/10.3389/fonc.2020.558548/). Another study focused on WHO grade II meningiomas demonstrated that the extent of resection is a critical predictor of overall and progression-free survival, emphasizing the importance of achieving gross total resection (ref: Soni doi.org/10.1007/s11060-020-03632-3/). Additionally, a prognostic model identified key factors associated with the benefits of adjuvant radiotherapy in high-grade meningioma patients, highlighting the complexity of treatment decisions (ref: Wang doi.org/10.3389/fonc.2020.568079/). Innovative approaches, such as endoscopic transorbital surgery for sphenoorbital meningiomas, have shown significant orbital decompression effects, with postoperative volume changes indicating successful intervention (ref: In Woo doi.org/10.1007/s00417-020-05008-9/). Lastly, comparisons between gamma knife icon and volumetric modulated arc therapy for stereotactic radiotherapy have provided insights into optimizing treatment planning for meningiomas (ref: Buatti doi.org/10.1002/acm2.13100/).

Prognostic factors and treatment strategies for meningiomas have been a focal point of recent research, particularly concerning high-grade tumors. A study examining mitotic and proliferative indices in WHO grade III meningiomas found significant correlations between these indices and progression-free survival, emphasizing the need for precise histopathological evaluation (ref: Daniela Maier doi.org/10.3390/cancers12113351/). Another investigation into gene expression signatures identified biologically homogeneous subgroups within grade II meningiomas, aiding in the prediction of clinical outcomes and treatment responses (ref: Zador doi.org/10.3389/fonc.2020.541928/). The role of frailty in postoperative outcomes has also been highlighted, with findings indicating that frail patients experience higher rates of complications and longer hospital stays, underscoring the importance of preoperative assessments (ref: Bonney doi.org/10.1016/j.wneu.2020.11.083/). Additionally, the management of postoperative pulmonary embolism in meningioma patients has been explored, with direct oral anticoagulants showing promise in treatment protocols (ref: Dubinski doi.org/10.1016/j.jocn.2020.09.059/). The simultaneous combined transcranial and endoscopic endonasal approach has been proposed as an effective strategy for preventing cerebrospinal fluid leaks in lateral skull base meningiomas, demonstrating the evolving nature of surgical techniques (ref: Matsuda doi.org/10.1016/j.jocn.2020.09.028/).

Genetic and molecular studies have provided valuable insights into the pathophysiology of meningiomas, particularly in understanding tumor behavior and treatment responses. Research on convexity meningiomas in patients with neurofibromatosis type 2 (NF2) indicated that Gamma Knife radiosurgery is a safe and effective treatment option, with a significant number of tumors responding positively to this intervention (ref: Ruiz-Garcia doi.org/10.1016/j.wneu.2020.10.153/). Additionally, a study assessing angiographic vascularity in meningiomas revealed that dynamic susceptibility contrast-perfusion-weighted imaging parameters could serve as clinical indicators for preoperative embolization, highlighting the importance of vascular characteristics in surgical planning (ref: Adachi doi.org/10.1007/s10143-020-01431-y/). The evaluation of crista galli pneumatization has also been linked to complications in anterior skull base surgeries, suggesting that anatomical variations can significantly impact surgical outcomes (ref: Akiyama doi.org/10.1016/j.jocn.2020.11.005/). Furthermore, the role of frailty in surgical outcomes has been emphasized, with studies showing that frail patients face increased risks of complications and longer recovery times (ref: Sastry doi.org/10.1016/j.jocn.2020.09.002/). These findings collectively underscore the need for personalized treatment approaches based on genetic and molecular profiling.

Clinical outcomes in meningioma management have been extensively studied, particularly regarding surgical techniques and postoperative complications. A meta-analysis on cerebrospinal fluid leak rates following the extended endoscopic endonasal approach revealed a significant decrease in leak rates over the past two decades, attributed to advancements in surgical techniques and closure methods (ref: Zamanipoor Najafabadi doi.org/10.1007/s00701-020-04641-x/). The effectiveness of fractionated stereotactic radiosurgery for perioptic meningiomas has been evaluated, demonstrating improved tumor control while managing the risk of vision injury (ref: Chen doi.org/10.1016/j.jocn.2020.09.058/). Additionally, the simultaneous combined transcranial and endoscopic endonasal approach has shown promise in preventing postoperative cerebrospinal fluid leaks, particularly in complex cases involving lateral skull base meningiomas (ref: Matsuda doi.org/10.1016/j.jocn.2020.09.028/). The development of hybrid deep learning models for tumor detection in brain MR images has also emerged as a significant advancement, potentially aiding in early diagnosis and treatment planning (ref: Toğaçar doi.org/10.1007/s11517-020-02290-x/). These studies collectively highlight the importance of integrating innovative techniques and technologies in improving clinical outcomes for meningioma patients.

Understanding complications and risk factors associated with meningioma surgery is crucial for improving patient outcomes. A study on the far-lateral approach for ventral and ventrolateral upper cervical meningiomas found no significant correlation between clinical outcomes and various factors such as tumor level or pathological subtype, indicating that this approach is generally safe and effective (ref: Abou-Madawi doi.org/10.31616/asj.2020.0270/). The management of symptomatic sellar and parasellar tumors during pregnancy has been explored, emphasizing the need for a practical algorithm to balance maternal and fetal health (ref: Zoli doi.org/10.1007/s11102-020-01107-2/). Additionally, the classification of crista galli pneumatization has been linked to the risk of cerebrospinal fluid leakage during anterior skull base surgeries, highlighting the importance of preoperative anatomical assessments (ref: Akiyama doi.org/10.1016/j.jocn.2020.11.005/). The impact of frailty on postoperative outcomes has been further substantiated, with studies indicating that frail patients face higher risks of complications and longer hospital stays (ref: Sastry doi.org/10.1016/j.jocn.2020.09.002/). These findings underscore the necessity of comprehensive preoperative evaluations and tailored surgical strategies to mitigate risks and enhance recovery.

Innovative techniques in the treatment of meningiomas have emerged, focusing on enhancing surgical precision and patient outcomes. The endoscopic transorbital approach for sphenoorbital meningiomas has demonstrated significant orbital decompression, with postoperative volume changes indicating effective intervention (ref: In Woo doi.org/10.1007/s00417-020-05008-9/). The use of gamma knife icon for stereotactic radiotherapy has been compared to volumetric modulated arc therapy, with findings suggesting that the former may provide superior dose distributions for selected meningioma cases (ref: Buatti doi.org/10.1002/acm2.13100/). Additionally, the development of a radiomics model to predict histopathological grading based on MRI has the potential to improve preoperative decision-making and treatment planning (ref: Han doi.org/10.1016/j.mri.2020.11.009/). These advancements reflect a growing trend towards personalized and minimally invasive approaches in meningioma management, aiming to optimize therapeutic outcomes while minimizing complications.