Recent studies have focused on optimizing treatment strategies for meningiomas, particularly in evaluating drug efficacy and the role of radiotherapy. The CEVOREM study highlighted the significance of the 3D volume growth rate (3DVGR) in assessing drug activity in aggressive meningiomas, revealing that 65.5% of lesions were stable or showed slight growth under treatment, with a mean pretreatment 3DVGR of 6.09% per month (ref: Graillon doi.org/10.1093/neuonc/). In another study, the roles of hENT1 and dCK were examined, demonstrating that these factors significantly contribute to gemcitabine sensitivity in high-grade meningiomas, suggesting potential targets for enhancing treatment efficacy (ref: Yamamoto doi.org/10.1093/neuonc/). Furthermore, the outcomes of stereotactic radiosurgery (SRS) for WHO grade 2 meningiomas were assessed, revealing a 3-year progression-free survival (PFS) rate that compares favorably to previous trials, indicating the effectiveness of SRS in this cohort (ref: Kowalchuk doi.org/10.1016/j.ijrobp.2021.01.048/). Contrastingly, the optimal radiation modality for recurrent WHO grade II meningiomas remains debated, with a study comparing IMRT and SRS showing varying PFS outcomes based on prior treatments (ref: Momin doi.org/10.1007/s11060-021-03711-z/). A systematic review and meta-analysis further explored the impact of adjuvant radiotherapy post-gross total resection (GTR) for atypical meningiomas, revealing conflicting results regarding local recurrence and survival, emphasizing the need for individualized treatment approaches (ref: Chun doi.org/10.1186/s13014-021-01759-9/).

The pathology and molecular mechanisms underlying meningiomas have garnered significant attention, particularly regarding their classification and prognostic indicators. Meningiomas, accounting for approximately 37% of intracranial tumors, are classified into three grades by the WHO based on recurrence risk and mortality (ref: Toland doi.org/10.1093/neuros/). Recent findings have shown that high levels of VEGF-A in WHO grade III meningiomas correlate with poor overall survival, highlighting the importance of angiogenesis in tumor progression (ref: Bernatz doi.org/10.1007/s10735-020-09940-2/). Additionally, the detection of postoperative residual meningioma using advanced imaging techniques has improved, with studies indicating that many patients with GTR may still harbor small residuals detectable by PET imaging (ref: Bashir doi.org/10.1158/1078-0432.CCR-20-3362/). Furthermore, the role of the MN1 gene in acute myeloid leukemia, which shares molecular features with meningiomas, suggests a potential link between these conditions and emphasizes the need for further exploration of shared pathways (ref: Libbrecht doi.org/10.1038/s41375-021-01146-z/). The application of multiscale fluorescence microscopy has also been shown to differentiate between meningioma grades and non-tumoral brain tissues, providing insights into tumor biology and potential therapeutic targets (ref: Mehidine doi.org/10.1038/s41598-020-78678-4/).

Innovative surgical and radiotherapy techniques are being explored to enhance treatment outcomes for meningiomas. A cohort study revealed that high doses of cyproterone acetate significantly increase the risk of intracranial meningiomas, with an adjusted hazard ratio of 21.7 for cumulative doses exceeding 60 g (ref: Weill doi.org/10.1136/bmj.n37/). The combination of metformin with cisplatin has shown promise in enhancing anti-cancer effects in high-grade meningiomas, indicating a potential therapeutic synergy that warrants further investigation (ref: Guo doi.org/10.1016/j.omto.2020.11.004/). Moreover, a study assessing the response of skull base meningiomas to conventionally fractionated stereotactic radiotherapy (CFSRT) found that short-axis diameter changes could serve as a simple indicator of tumor response, providing a practical metric for clinical assessments (ref: Takehana doi.org/10.1007/s00330-021-07707-1/). The long-term outcomes of meningiomas involving major dural sinuses were also evaluated, showing that combined therapy of subtotal resection and early postoperative gamma knife radiosurgery significantly improved progression-free survival rates compared to surgery alone (ref: Lv doi.org/10.1007/s00701-021-04766-7/). These findings underscore the evolving landscape of meningioma management, highlighting the importance of personalized treatment strategies.

Understanding the risk factors and prognostic indicators associated with meningiomas is crucial for improving patient outcomes. The use of high-dose cyproterone acetate has been linked to a significantly increased risk of developing meningiomas, with a notable reduction in risk observed after treatment discontinuation, emphasizing the need for careful monitoring in patients receiving this medication (ref: Weill doi.org/10.1136/bmj.n37/). Additionally, a systematic review and meta-analysis on adjuvant radiotherapy following gross total resection for atypical meningiomas revealed conflicting evidence regarding its impact on local recurrence and survival, suggesting that further research is needed to clarify its role in treatment protocols (ref: Chun doi.org/10.1186/s13014-021-01759-9/). The evolutionary model of circulating tumor cells (CTCs) in brain tumors has also been proposed, indicating that the presence and characteristics of CTCs may serve as important prognostic indicators (ref: Mehdipour doi.org/10.5306/wjco.v12.i1.13/). Furthermore, a study examining tumor response indicators post-CFSRT found that short-axis diameter changes could effectively predict treatment outcomes, providing a valuable tool for clinicians in assessing therapeutic efficacy (ref: Takehana doi.org/10.1007/s00330-021-07707-1/). These insights into risk factors and prognostic indicators are essential for developing more effective management strategies for meningioma patients.

Advancements in neuroimaging and diagnostic techniques are enhancing the evaluation and management of meningiomas. A study utilizing three-dimensional virtual reality (3D-VR) reconstructions demonstrated improved identification of anatomical structures and surgical planning for patients with anterior skull base meningiomas compared to conventional imaging methods (ref: Zawy Alsofy doi.org/10.3390/jcm10040681/). Additionally, research on peritumoral brain edema (PTBE) volume in meningiomas revealed a correlation with tumor fractional anisotropy, suggesting that diffusion properties may provide insights into tumor behavior and patient outcomes (ref: Toh doi.org/10.1007/s00234-021-02646-6/). The protean manifestations of IgG4-related hypertrophic pachymeningitis were also explored, highlighting the diagnostic challenges posed by conditions that can mimic meningiomas (ref: Woo doi.org/10.1186/s41016-021-00233-5/). Furthermore, the analysis of clear cell meningiomas using the SEER database has provided valuable epidemiological data, aiding in the understanding of this rare subtype's clinical outcomes (ref: Wang doi.org/10.3389/fonc.2020.592800/). These developments in neuroimaging and diagnostic techniques are pivotal in refining the approach to meningioma management.

The impact of meningiomas on cognitive function and quality of life is an emerging area of research, with studies highlighting the protective role of cognitive reserve. One study found that cognitive reserve, characterized by factors such as IQ and occupational attainment, may protect against cognitive decline in patients with brain tumors, suggesting that enhancing cognitive reserve could be beneficial for patient outcomes (ref: Campanella doi.org/10.1016/j.neuropsychologia.2021.107769/). Additionally, research on the factors influencing return to work after brain tumor surgery indicated that better preoperative and postoperative cognitive scores, along with lower disability levels, were associated with successful reintegration into the workforce for meningioma patients (ref: Schiavolin doi.org/10.3389/fnhum.2020.609080/). The evolutionary model of circulating tumor cells (CTCs) also suggests that the characteristics of these cells may influence cognitive outcomes, emphasizing the need for personalized approaches in managing cognitive health in meningioma patients (ref: Mehdipour doi.org/10.5306/wjco.v12.i1.13/). These findings underscore the importance of addressing cognitive and quality of life outcomes in the holistic management of meningioma patients.

Emerging therapeutics and the challenge of drug resistance in meningiomas are critical areas of ongoing research. The combination of metformin with cisplatin has shown enhanced anti-cancer effects in high-grade meningiomas, indicating a potential strategy to overcome resistance and improve treatment efficacy (ref: Guo doi.org/10.1016/j.omto.2020.11.004/). Additionally, a study on the response of skull base meningiomas to conventionally fractionated stereotactic radiotherapy (CFSRT) identified short-axis diameter changes as a useful indicator of tumor response, which could aid in monitoring treatment effectiveness and adjusting therapeutic strategies (ref: Takehana doi.org/10.1007/s00330-021-07707-1/). Furthermore, the surgical management of tentorial notch meningiomas has been refined through a proposed classification system, which may enhance surgical outcomes and reduce complications (ref: Qin doi.org/10.3389/fonc.2020.609056/). These advancements in therapeutic approaches and the understanding of drug resistance mechanisms are essential for improving the management of meningiomas and addressing the challenges posed by treatment resistance.

Comparative studies and meta-analyses play a vital role in synthesizing evidence for meningioma management. A systematic review on adjuvant radiotherapy versus observation following gross total resection for atypical meningiomas revealed conflicting results, underscoring the need for further research to clarify the benefits of adjuvant treatment in this population (ref: Chun doi.org/10.1186/s13014-021-01759-9/). Additionally, a retrospective cohort study comparing salvage radiation modalities for recurrent WHO grade II meningiomas found variations in progression-free survival outcomes, highlighting the importance of individualized treatment plans based on patient history and tumor characteristics (ref: Momin doi.org/10.1007/s11060-021-03711-z/). These comparative analyses are crucial for guiding clinical decision-making and optimizing treatment strategies for meningioma patients, ensuring that emerging evidence is effectively integrated into practice.