Recent studies have focused on various treatment modalities for meningiomas, particularly high-grade variants which pose significant challenges due to their aggressive nature and limited therapeutic options. A phase 2 trial evaluated pembrolizumab, a PD-1 inhibitor, in 25 patients with recurrent high-grade meningiomas, revealing potential efficacy in this difficult-to-treat population (ref: Brastianos doi.org/10.1038/s41467-022-29052-7/). In contrast, a comparative analysis of active surveillance versus stereotactic radiosurgery (SRS) for incidental frontobasal meningiomas demonstrated that SRS resulted in a 0% progression rate compared to 52% in the active surveillance cohort (ref: Islim doi.org/10.3390/cancers14051300/). This suggests that SRS may be a more effective intervention for certain meningioma patients, particularly those with asymptomatic tumors, as further supported by a matched cohort analysis from the IMPASSE study, which found significant differences in local control rates (ref: Pikis doi.org/10.1227/neu.0000000000001924/). The role of preoperative embolization in improving surgical outcomes for giant meningiomas remains contentious. A matched cohort study indicated that embolization did not significantly enhance surgical or functional outcomes, highlighting the need for further investigation into its efficacy (ref: Yin doi.org/10.3389/fonc.2022.852327/). Additionally, a retrospective analysis of adjuvant radiotherapy for grade 2 meningiomas found no survival or local recurrence benefits, suggesting that current treatment paradigms may require reevaluation (ref: Rebchuk doi.org/10.1016/j.wneu.2022.02.088/). These findings collectively underscore the complexity of managing meningiomas and the necessity for tailored treatment strategies based on tumor characteristics and patient profiles.

Surgical techniques for meningioma resection have evolved, with a focus on optimizing outcomes and minimizing complications. A study detailing the clinical history and outcomes of 51 patients with malignant meningiomas highlighted the heterogeneous nature of these tumors and the importance of individualized treatment approaches (ref: Maier doi.org/10.3171/2022.1.JNS212723/). The surgical management of sphenoid wing meningiomas with periorbital invasion was also examined, revealing that gross total resection (GTR) is critical for improving clinical outcomes in these challenging cases (ref: Park doi.org/10.3340/jkns.2021.0109/). Furthermore, the extended intradural anterior transpetrous approach (ATPA) was proposed as an effective technique for resecting petroclival meningiomas, allowing access to both the sellar region and the cerebellopontine angle (ref: Bai doi.org/10.1080/02688697.2021.1999393/). Innovative technologies such as a 5-aminolevulinic acid-enabled surgical loupe system have shown promise in enhancing visualization during tumor resections, potentially leading to improved surgical outcomes (ref: Zhang doi.org/10.1227/ons.0000000000000141/). Additionally, hypofractionated Gamma Knife radiosurgery (GKRS) has emerged as a viable treatment option for patients who are not surgical candidates, demonstrating effectiveness and safety in managing both benign and malignant tumors (ref: Inserra doi.org/10.21873/anticanres.15661/). These advancements in surgical techniques and technologies reflect a broader trend towards personalized and minimally invasive approaches in neurosurgery, aiming to enhance patient outcomes while reducing morbidity.

Radiotherapy remains a critical component in the management of meningiomas, particularly for patients with higher-risk profiles. A recursive partitioning analysis identified prognostic factors that could guide the use of adjuvant radiotherapy, indicating that intermediate and high-risk groups benefit significantly from this treatment modality (ref: Chang doi.org/10.1227/neu.0000000000001904/). In pediatric populations, gamma knife radiosurgery (GKRS) has been shown to be an effective treatment for central nervous system tumors, with a retrospective study confirming its efficacy in managing 61 neoplasms (ref: Mishra doi.org/10.1007/s00381-022-05463-1/). The role of stereotactic radiosurgery (SRS) in treating petroclival meningiomas has been systematically reviewed, with findings suggesting that SRS can be utilized effectively as either a primary or adjuvant treatment, contributing to improved clinical outcomes (ref: Bin Alamer doi.org/10.1007/s11060-021-03934-0/). Moreover, a study examining the association of hormonal contraception with meningioma location found a significant correlation, indicating that hormonal factors may influence tumor development (ref: Malueka doi.org/10.31557/APJCP.2022.23.3.1047/). These insights into radiotherapy and hormonal influences on meningiomas underscore the complexity of treatment planning and the need for a multidisciplinary approach in managing these tumors.

Molecular profiling of meningiomas has gained attention as a means to better understand tumor behavior and inform treatment strategies. A study revealed discrepancies between standard histological grading and molecular profiles, suggesting that advanced molecular profiling could identify meningiomas with aggressive characteristics that may not be apparent through traditional grading methods (ref: Roehrkasse doi.org/10.3389/fonc.2022.846232/). Furthermore, targeting DNA methyltransferases with decitabine in cultured meningiomas has been proposed as a potential therapeutic strategy, highlighting the importance of epigenetic modifications in tumor progression and treatment response (ref: Tatman doi.org/10.1016/j.wneu.2022.02.108/). The exploration of hypofractionated GKRS also revealed promising results in managing both benign and malignant tumors, suggesting that this approach could be beneficial in cases where traditional surgical options are limited (ref: Inserra doi.org/10.21873/anticanres.15661/). Additionally, the findings from the IMPASSE study on the effectiveness of SRS compared to active surveillance for asymptomatic meningiomas further emphasize the need for integrating molecular insights into clinical decision-making (ref: Pikis doi.org/10.1227/neu.0000000000001924/). Collectively, these studies illustrate the evolving landscape of meningioma research, where molecular and genetic insights are increasingly guiding therapeutic approaches and improving patient outcomes.

Advancements in imaging and diagnostic techniques are crucial for the accurate assessment and management of meningiomas. A novel asymmetric convolutional neural network (CNN) was developed to differentiate between Grade I and II meningiomas using magnetic resonance imaging (MRI), demonstrating the potential for automated classification to enhance diagnostic accuracy (ref: Vassantachart doi.org/10.1038/s41598-022-07859-0/). Another study introduced a new MRI diagnosis method based on CNN and Bayesian optimization, which aims to improve brain tumor classification and facilitate timely treatment planning (ref: Ait Amou doi.org/10.3390/healthcare10030494/). The importance of accurate imaging is further underscored by findings from a retrospective analysis of adjuvant radiotherapy outcomes for Grade 2 meningiomas, which revealed no significant survival or recurrence benefits, suggesting that imaging may play a critical role in treatment decision-making (ref: Rebchuk doi.org/10.1016/j.wneu.2022.02.088/). These innovations in imaging technology not only enhance diagnostic capabilities but also contribute to a more nuanced understanding of tumor characteristics, ultimately guiding more effective treatment strategies.

The impact of neurosurgery on patient outcomes and quality of life is a critical area of research, particularly in the context of brain tumors. A study investigating fatigue in patients post-neurosurgery found that sleep disturbances significantly correlated with levels of physical and mental fatigue, indicating that addressing sleep issues may be essential for improving patient recovery and quality of life (ref: Kitselaar doi.org/10.1016/j.jpsychores.2022.110766/). Additionally, the clinical outcomes of preoperative embolization for giant meningiomas were assessed, revealing that while embolization may not significantly enhance surgical outcomes, it remains a topic of ongoing debate in the field (ref: Yin doi.org/10.3389/fonc.2022.852327/). The evolution of surgical techniques, such as the final cut method for cavernous sinus decompression, aims to improve safety and outcomes by allowing for more precise resection while minimizing risks to surrounding structures (ref: Peto doi.org/10.1227/ons.0000000000000128/). Furthermore, a case report highlighted the rapid growth of cicatricial fibromatosis following meningioma removal, emphasizing the need for careful monitoring of postoperative complications that can affect patient quality of life (ref: Kanbara doi.org/10.22603/ssrr.2021-0010/). These findings collectively underscore the importance of considering patient-reported outcomes and quality of life in the context of neurosurgical interventions.

Research into the biology and pathophysiology of meningiomas continues to uncover critical insights into tumor behavior and risk factors. A large-scale study examining cellular telephone use and its association with brain tumors found no significant links, contributing to the ongoing debate regarding environmental risk factors for tumor development (ref: Schüz doi.org/10.1093/jnci/). In contrast, the role of indolethylamine-N-methyltransferase (INMT) in prostate cancer was explored, revealing its potential involvement in regulating tumor microenvironments and signaling pathways, which may have implications for understanding similar mechanisms in meningiomas (ref: Jianfeng doi.org/10.3389/fcell.2022.805402/). The findings from a phase 2 study on pembrolizumab in high-grade meningiomas highlighted the immunosuppressive tumor microenvironment and the potential for targeted therapies to improve outcomes in this challenging patient population (ref: Brastianos doi.org/10.1038/s41467-022-29052-7/). Additionally, research into modified dural closure techniques in extended transsphenoidal surgery has provided insights into the biological responses of dural tissues, further informing surgical practices (ref: Nagata doi.org/10.2176/jns-nmc.2021-0355/). These studies collectively enhance our understanding of meningioma biology and underscore the need for continued exploration of tumor pathophysiology to inform therapeutic strategies.