Recent studies have focused on various treatment modalities and prognostic factors for meningiomas, particularly in challenging cases such as recurrent and atypical tumors. One study explored the efficacy of salvage surgery combined with reirradiation for skull base meningiomas that had previously undergone radiotherapy. The findings indicated that while gross total resection (GTR) did not significantly improve progression-free survival (PFS) for WHO grade II meningiomas, adjuvant reirradiation after subtotal resection (STR) was associated with improved outcomes (HR 0.316, p = 0.0029) (ref: Rubino doi.org/10.3171/2022.12.JNS222010/). Another study assessed the long-term efficacy of single-session stereotactic radiosurgery (SRS) for large perioptic meningiomas, reporting a median tumor volume of 15 cm3 and a median prescription dose of 12 Gy, highlighting the potential of SRS as a viable treatment option (ref: El-Shehaby doi.org/10.3171/2023.1.JNS221951/). Furthermore, genomic markers have emerged as critical predictors of recurrence risk in atypical meningiomas following GTR, with specific copy number variants (CNVs) identified as strong predictors of decreased recurrence-free survival (ref: Vaubel doi.org/10.1093/noajnl/). These findings underscore the need for personalized treatment approaches based on tumor characteristics and molecular profiles. In addition to surgical and radiotherapeutic strategies, novel therapeutic avenues are being investigated. One study highlighted the potential of inhibiting the miR-483-5p/IGF-2 pathway, which resulted in a significant reduction in meningioma cell viability (ref: Uhlmann doi.org/10.1007/s11060-023-04264-z/). The meningioma vascularity index (MVI) has also been proposed as a preoperative marker to predict intraoperative blood loss and the likelihood of subtotal resection, emphasizing the importance of vascularity in surgical planning (ref: Ghodrati doi.org/10.1007/s11060-023-04259-w/). Overall, these studies reflect a multifaceted approach to meningioma management, integrating surgical techniques, radiotherapy, and emerging molecular therapies to optimize patient outcomes.

The molecular landscape of meningiomas has garnered significant attention, particularly regarding the genetic alterations that influence tumor behavior and treatment response. A pivotal study identified the loss of p16 expression as a sensitive marker for CDKN2A homozygous deletion in malignant meningiomas, suggesting that genomic profiling can refine classification and prognostication beyond traditional histopathological methods (ref: Tang doi.org/10.1007/s00401-023-02544-6/). This aligns with findings from another study that performed comprehensive genomic analysis on atypical meningiomas, revealing that specific CNVs, such as -1p and -10q, are strong predictors of recurrence-free survival following gross total resection (ref: Vaubel doi.org/10.1093/noajnl/). These insights highlight the potential for integrating molecular markers into clinical practice to guide management decisions. Additionally, the expression of biomarkers related to tumor invasiveness has been explored. The study on canstatin expression demonstrated that low levels of this angiogenesis inhibitor correlate with brain-invasive meningiomas, providing a basis for understanding the mechanisms underlying aggressive tumor behavior and potential therapeutic targets (ref: Pei doi.org/10.1007/s11060-023-04256-z/). Furthermore, the relationship between connexin-43 expression and Ki67 in non-glial CNS tumors suggests that intercellular communication may play a role in tumor proliferation, warranting further investigation into its implications for meningioma biology (ref: Krigers doi.org/10.1177/03936155221143138/). Collectively, these studies underscore the importance of molecular and genetic insights in shaping the future of meningioma diagnosis and treatment.

Advancements in imaging techniques have significantly enhanced the diagnostic accuracy and management of meningiomas. A study investigating the rim-enhancing pattern on contrast-enhanced FLAIR MRI demonstrated its efficacy in distinguishing meningiomas from malignant dural-based tumors, with a notable presence of this pattern in 89.2% of meningiomas compared to only 6.5% in malignant cases (ref: Panyaping doi.org/10.3174/ajnr.A7780/). This finding emphasizes the potential of specific MRI characteristics to improve preoperative assessments and surgical planning. Moreover, a radiomics nomogram developed from contrast-enhanced MRI data has shown promise in predicting the expression status of the Ki-67 proliferative index in meningiomas, suggesting that integrating radiological features with machine learning techniques can enhance preoperative risk stratification (ref: Ouyang doi.org/10.21037/qims-22-689/). Another study utilized dynamic susceptibility contrast MRI to differentiate between paragangliomas and meningiomas, highlighting the utility of advanced imaging modalities in clinical decision-making (ref: Ota doi.org/10.1016/j.clinimag.2022.12.014/). These innovations in imaging not only facilitate accurate diagnosis but also contribute to personalized treatment strategies based on tumor characteristics.

Surgical techniques for meningioma resection have evolved, with various approaches being tailored to tumor location and characteristics. A retrospective review of the transpalpebral eyelid approach for supraorbital frontal craniotomy demonstrated its safety and effectiveness in accessing the anterior cranial fossa, achieving total resection in a significant proportion of cases (ref: Morrison doi.org/10.1097/PRS.0000000000009928/). This minimally invasive technique offers an alternative to traditional approaches, potentially reducing recovery time and complications. In the context of giant tuberculum sellae meningiomas, a comparative analysis of the unilateral subfrontal approach versus endoscopic transsphenoidal approach revealed that both techniques achieved high rates of gross total resection, with the unilateral subfrontal approach yielding a total resection rate of 87% (ref: Li doi.org/10.3389/fsurg.2022.990646/). The choice of surgical approach is critical, particularly in complex cases where neurovascular structures are involved. Additionally, the application of single-session stereotactic radiosurgery for large perioptic meningiomas has shown promising long-term efficacy, indicating that non-invasive techniques can complement surgical interventions (ref: El-Shehaby doi.org/10.3171/2023.1.JNS221951/). These advancements reflect a trend towards individualized surgical strategies that prioritize patient safety and optimal outcomes.

Understanding the characteristics and risk factors associated with meningiomas is essential for effective management and treatment planning. A study on solitary fibrous tumors/hemangiopericytomas of the CNS developed prognostic risk categories that predict survival benefits from radiotherapy, particularly highlighting the importance of stratifying patients based on risk (ref: Kinslow doi.org/10.3390/cancers15030876/). This approach underscores the need for tailored treatment strategies that consider individual tumor biology and patient factors. Furthermore, the preoperative meningioma vascularity index (MVI) has been identified as a significant predictor of intraoperative blood loss and the likelihood of subtotal resection, emphasizing the role of vascularity in surgical outcomes (ref: Ghodrati doi.org/10.1007/s11060-023-04259-w/). Additionally, MRI features such as the lobulated sign and tumor-brain interface have been shown to correlate with WHO grade and brain invasion, providing valuable information for preoperative planning and risk assessment (ref: Jiang doi.org/10.3389/fonc.2022.1100350/). These findings highlight the importance of integrating tumor characteristics into clinical decision-making to optimize patient management.

Clinical outcomes in meningioma management are influenced by various factors, including tumor characteristics, treatment modalities, and patient-specific variables. A study examining serum interleukin-1 levels found associations with intracranial aneurysm instability, suggesting potential biomarkers for monitoring disease progression (ref: Liu doi.org/10.1007/s12975-023-01140-w/). This highlights the importance of identifying inflammatory markers that may correlate with tumor behavior and patient outcomes. Moreover, advancements in imaging and diagnostic techniques have facilitated improved tumor characterization and management strategies. For instance, a study utilizing a CNN-based classifier demonstrated high accuracy in differentiating gliomas from other brain tumors, showcasing the potential of artificial intelligence in enhancing diagnostic precision (ref: Papadomanolakis doi.org/10.3390/brainsci13020348/). Additionally, the analysis of CyberKnife treatment plans using ICRU 91 dose reporting metrics has provided insights into the implementation of standardized protocols in stereotactic treatments, which may enhance treatment consistency and patient safety (ref: Conlon doi.org/10.1002/acm2.13932/). Collectively, these studies emphasize the need for a multidisciplinary approach to patient management, integrating clinical, radiological, and molecular data to optimize outcomes.

Emerging therapies and biomarkers are at the forefront of advancing treatment options for meningiomas. Recent studies have focused on the inhibition of specific molecular pathways, such as the miR-483-5p/IGF-2 pathway, which has shown promise in reducing meningioma cell viability, indicating a potential therapeutic target for future interventions (ref: Uhlmann doi.org/10.1007/s11060-023-04264-z/). This highlights the importance of exploring novel pharmacological agents that can complement existing treatment modalities. Additionally, the expression of canstatin, an angiogenesis inhibitor, has been linked to brain invasion in meningiomas, suggesting that understanding the molecular underpinnings of tumor behavior can inform personalized treatment strategies (ref: Pei doi.org/10.1007/s11060-023-04256-z/). Furthermore, the relationship between connexin-43 expression and tumor proliferation, as assessed through immunohistochemistry, may provide insights into the biological behavior of meningiomas and their response to therapy (ref: Krigers doi.org/10.1177/03936155221143138/). These findings underscore the potential for integrating molecular biomarkers into clinical practice, paving the way for targeted therapies that can improve patient outcomes and reduce recurrence rates.