The management of meningiomas, particularly high-grade variants, poses significant challenges due to their aggressive nature and resistance to conventional therapies. A study evaluated the efficacy of a procaspase-3 activator, PAC-1, in combination with hydroxyurea (HU) or temozolomide (TMZ) in canine patients with high-grade meningioma. Results indicated that while PAC-1 + HU stabilized the disease without inducing apoptosis, PAC-1 + TMZ successfully reduced tumor burden in all treated canines (ref: Tonogai doi.org/10.1093/neuonc/). Additionally, a phase 0 clinical trial assessed everolimus, an mTORC1 inhibitor, in patients with vestibular schwannoma or meningioma prior to surgery. The study aimed to understand the pharmacokinetics and potential resistance mechanisms, revealing that everolimus could slow tumor progression in specific patient subsets (ref: Karajannis doi.org/10.1158/1535-7163.MCT-21-0143/). Furthermore, the incidence of benign meningiomas in the U.S. showed an overall increase until 2010, after which it stabilized, with projections indicating a potential decline in older age groups (ref: Bhala doi.org/10.1093/jncics/). This highlights the importance of ongoing monitoring and tailored treatment strategies in managing meningiomas effectively. A retrospective study also examined the impact of red blood cell transfusions during elective meningioma resections, finding that transfusions were associated with increased morbidity and prolonged hospital stays, emphasizing the need for careful preoperative planning (ref: Neef doi.org/10.3390/cancers13143601/).

Recent advancements in understanding the molecular landscape of meningiomas have been facilitated by the establishment of patient-derived organoid models, which closely mimic the histological and molecular characteristics of parental tumors. This innovative approach allows for more accurate assessments of therapeutic responses and molecular profiling (ref: Yamazaki doi.org/10.1093/neuonc/). In a related study, the drug brigatinib demonstrated significant tumor shrinkage in NF2-deficient meningiomas and schwannomas by inhibiting multiple tyrosine kinases, showcasing the potential for targeted therapies in genetically defined tumor subsets (ref: Chang doi.org/10.1371/journal.pone.0252048/). Additionally, research into microRNA dysregulation in canine meningiomas revealed critical insights into the role of these small non-coding RNAs in tumorigenesis, suggesting that similar mechanisms may be present in human cases (ref: Foiani doi.org/10.1093/jnen/). The differential expression of hypoxia-related genes has also been explored, with findings indicating their potential utility in differentiating between gliomas and meningiomas, thus aiding in diagnostic accuracy (ref: Bayat doi.org/10.1016/j.wneu.2021.07.068/).

The epidemiological landscape of meningiomas has been characterized by a notable increase in incidence rates, particularly among benign variants, which stabilized after 2010. Projections suggest that the incidence may decline among older populations while remaining stable in younger age groups (ref: Bhala doi.org/10.1093/jncics/). A meta-analysis further investigated the prevalence of incidental meningiomas and gliomas, revealing a prevalence of 0.064% for gliomas across a large cohort, although no significant correlations were found with age or sex (ref: Nakasu doi.org/10.1007/s00701-021-04919-8/). This underscores the necessity for ongoing surveillance and research into the demographic factors influencing meningioma prevalence. Moreover, advancements in technology, such as IoMT-enabled CAD systems, are transforming diagnostic practices, enhancing the detection and classification of brain tumors, including meningiomas (ref: Sekhar doi.org/10.1109/JBHI.2021.3100758/).

Surgical management of meningiomas, particularly spinal variants, requires careful consideration of long-term outcomes and complications. A population-based cohort study focused on spinal meningiomas highlighted the importance of identifying predictors of functional improvement post-surgery, revealing that age and tumor characteristics significantly influence outcomes (ref: Pettersson-Segerlind doi.org/10.3390/cancers13133244/). Additionally, the surgical challenges posed by ossified spinal meningiomas were addressed through a technical note that provided insights into effective microsurgical techniques for complete resection (ref: Thakur doi.org/10.3171/2020.12.SPINE201526/). Another study examined the limitations of endoscopic endonasal approaches for midline anterior skull base meningiomas, noting a residual tumor rate of 11%, which emphasizes the need for refined surgical strategies (ref: Setty doi.org/10.1093/ons/). Furthermore, a review of pediatric meningiomas indicated distinct clinical features and outcomes compared to adults, necessitating tailored management approaches for this demographic (ref: Liu doi.org/10.1007/s00381-021-05296-4/).

Innovations in diagnostic imaging for neuro-oncology are paving the way for improved detection and treatment planning for meningiomas. A study evaluating the potential of deep learning to replace gadolinium in neuro-oncology demonstrated high sensitivity and positive predictive value for lesion detection, although performance decreased with smaller lesions (ref: Ammari doi.org/10.1097/RLI.0000000000000811/). Additionally, the use of 68Ga-DOTATOC-PET/MRI has emerged as a promising tool for target volume contouring in robotic radiosurgery for optic nerve sheath meningiomas, enhancing diagnostic accuracy and treatment safety (ref: Graef doi.org/10.3390/cancers13133305/). These advancements highlight the critical role of imaging technologies in refining treatment strategies and improving patient outcomes in neuro-oncology.

The impact of meningiomas on patient quality of life and outcomes is an area of growing research interest. A study investigating sleep disturbances in adults with untreated pituitary tumors and meningiomas found that sleep quality significantly correlated with preoperative quality of life, underscoring the importance of addressing sleep issues in this patient population (ref: Lin doi.org/10.1007/s11060-021-03811-w/). Additionally, research into the mechanisms preventing invasion and metastasis in benign tumors highlighted the role of chloride intracellular channel protein 2 (CLIC2) in inhibiting MMP14 activity, suggesting potential therapeutic targets for improving patient outcomes (ref: Ozaki doi.org/10.1016/j.neo.2021.06.001/). These findings emphasize the need for comprehensive care strategies that consider both physical and psychological aspects of patient health in meningioma management.

Preclinical models are essential for advancing our understanding of meningiomas and developing targeted therapies. The establishment of patient-derived organoid models has provided a platform for studying the molecular alterations associated with meningiomas, allowing for more effective drug testing and therapeutic strategies (ref: Yamazaki doi.org/10.1093/neuonc/). In a study focused on NF2-related tumors, brigatinib was shown to induce tumor shrinkage by targeting multiple tyrosine kinases, demonstrating the potential for personalized medicine in treating genetically defined meningiomas (ref: Chang doi.org/10.1371/journal.pone.0252048/). Furthermore, the analysis of microRNA expression in canine meningiomas revealed dysregulation patterns that may also be relevant to human cases, suggesting avenues for further research into the role of miRNAs in tumorigenesis (ref: Foiani doi.org/10.1093/jnen/).

Understanding the complications and risk factors associated with meningioma surgery is critical for improving patient safety and outcomes. A study identified six preoperative factors significantly associated with major adverse events during first-time intracranial meningioma surgeries, highlighting the need for thorough preoperative assessments (ref: Jenkins doi.org/10.1007/s00701-021-04897-x/). Additionally, long-term follow-up of high-grade meningioma patients revealed no significant survival differences between treatment strategies, although progression-free survival was notably better in those receiving radiotherapy (ref: Simonetti doi.org/10.1016/j.clineuro.2021.106808/). This underscores the complexity of managing high-grade meningiomas and the necessity for individualized treatment plans that consider both the risks and benefits of various interventions.