The management of meningiomas, particularly incidental cases, has evolved with the introduction of clinical tools such as the IMPACT tool, which stratifies patients into categories for early intervention, serial monitoring, or safe discharge from outpatient care based on the risk of progression (ref: Islim doi.org/10.1001/jamaoncol.2025.4821/). Additionally, DNA methylation profiling has emerged as a robust method for predicting postsurgical outcomes and responses to radiotherapy, leading to the establishment of a clinical decision-making framework that integrates molecular models into practice (ref: Landry doi.org/10.1093/neuonc/). The prognostic significance of molecular classifications, particularly in patients treated with stereotactic radiosurgery, has been highlighted, revealing that certain genetic alterations, such as 1q gain, negatively impact tumor control and survival rates (ref: Umekawa doi.org/10.1186/s40478-025-02153-2/). Furthermore, studies on the occurrence of brain necrosis after intensity-modulated proton therapy indicate that dose and dose-averaged linear energy transfer (LET) play critical roles in adverse outcomes, emphasizing the need for careful treatment planning (ref: Bazani doi.org/10.1016/j.radonc.2025.111290/). A survey on reirradiation practices for recurrent brain tumors underscores the variability in clinical approaches, reflecting the ongoing challenges in standardizing care (ref: Turcas doi.org/10.1016/j.radonc.2025.111299/).

Recent research has unveiled significant molecular and genetic insights into meningiomas, particularly focusing on genetic drivers and their implications for treatment. A notable study identified a subgroup of meningiomas characterized by FOS and FOSB gene fusions, which may represent a distinct molecular entity among tumors lacking known genetic alterations (ref: Yalcin doi.org/10.1038/s41467-025-65549-7/). Additionally, the role of Meflin/ISLR as a meningeal cell-specific marker has been explored, shedding light on its involvement in meningioma progression and the complexities of meningeal development (ref: Shiraki doi.org/10.1111/bpa.70048/). The therapeutic potential of targeting SLC7A1 has also been highlighted, with studies demonstrating that its knockdown significantly inhibits meningioma cell proliferation and invasion, suggesting a promising avenue for future therapies (ref: Song doi.org/10.1038/s41420-025-02783-4/). Moreover, integrated metabolomics and lipidomics analyses have revealed distinct metabolic pathways associated with meningioma grades, providing insights into the molecular mechanisms underlying tumor progression (ref: Halder doi.org/10.1021/acs.jproteome.5c00663/).

Technological advancements in imaging and detection have significantly enhanced the diagnosis and management of meningiomas. A study utilizing unsupervised generative AI demonstrated its potential in improving brain tumor segmentation in scenarios with incomplete real-world data, addressing a critical limitation in current imaging practices (ref: Li doi.org/10.1038/s41698-025-01173-4/). Additionally, a self-supervised text-vision framework was developed to detect abnormalities in brain MRI scans, leveraging free-text neuroradiology reports, which could streamline the diagnostic process without the need for expert-labeled datasets (ref: Wood doi.org/10.1148/ryai.240619/). The exploration of automated detection methods using skull X-ray images has shown promising results, with a hybrid model achieving high accuracy in identifying meningiomas (ref: Kim doi.org/10.1038/s41598-025-23933-9/). Furthermore, the development of deep learning-based models for detecting spinal schwannomas and meningiomas highlights the potential for AI to facilitate early diagnosis and improve clinical decision-making (ref: Liu doi.org/10.1007/s11517-025-03468-x/).

Understanding recurrence and prognosis in meningioma patients is critical for optimizing treatment strategies. A multicenter cohort study revealed a significant second peak in recurrence for patients who underwent subtotal resection (STR) at 7 to 10 years postoperatively, emphasizing the need for long-term follow-up and monitoring in this patient population (ref: Teng doi.org/10.1002/cncr.70200/). The variability in clinical practices regarding reirradiation for recurrent brain tumors was highlighted in a survey, indicating a lack of standardized guidelines and the necessity for evidence-based protocols (ref: Turcas doi.org/10.1016/j.radonc.2025.111299/). A systematic review comparing single-session versus hypofractionated stereotactic radiosurgery for large meningiomas found that hypofractionated approaches were more commonly used for larger tumors, although they also presented higher risks of radiation-induced toxicity (ref: Pahwa doi.org/10.1007/s11060-025-05348-8/). Additionally, a case report on the delayed regression of atypical meningiomatosis following the cessation of gender-affirming hormone therapy underscores the complexities of hormonal influences on tumor behavior (ref: Goacher doi.org/10.1080/02688697.2025.2586008/).

Radiotherapy and stereotactic approaches have become integral to the treatment of meningiomas, with multifraction Gamma Knife radiosurgery (mf-GKRS) showing promise in managing large tumors. A single-institute cohort study reported on the efficacy and risk factors associated with mf-GKRS, emphasizing the need for careful patient selection to minimize adverse effects (ref: Barzaghi doi.org/10.1227/ons.0000000000001842/). Investigations into the role of dose and dose-averaged LET in the occurrence of brain necrosis following intensity-modulated proton therapy have highlighted the importance of optimizing treatment parameters to reduce complications (ref: Bazani doi.org/10.1016/j.radonc.2025.111290/). Furthermore, the management of CNS tumors during pregnancy has been explored, revealing the complexities of neurosurgical interventions in this unique patient population and their long-term implications for offspring neurodevelopment (ref: Karataş doi.org/10.1016/j.wneu.2025.124631/).

Patient outcomes and quality of life following meningioma surgery are critical areas of investigation. A study examining sex-specific disparities in postoperative adverse events revealed that gender differences significantly influence morbidity, underscoring the need for tailored perioperative management strategies (ref: Lenga doi.org/10.1007/s00701-025-06708-z/). Comparative outcomes of different surgical approaches for large anterior skull base meningiomas indicated that bifrontal craniotomies were associated with higher rates of complications and worse cosmetic outcomes compared to other techniques, highlighting the importance of surgical choice in patient recovery (ref: Akkara doi.org/10.1227/ons.0000000000001830/). Additionally, the use of advanced imaging techniques, such as apparent diffusion coefficient (ADC) ratios, has been evaluated for preoperative assessment of meningioma grade, although findings indicated poor diagnostic performance, suggesting a need for further refinement in imaging methodologies (ref: Navarro-Ballester doi.org/10.1016/j.neuchi.2025.101743/).

Innovations in neurosurgical techniques have significantly impacted the management of meningiomas. The endoscopic pre-subtemporal keyhole approach has been validated for its anatomical feasibility and clinical applications, providing a minimally invasive corridor for accessing critical neurovascular structures (ref: Lim doi.org/10.1016/j.bas.2025.105637/). Furthermore, the management of CNS tumors during pregnancy has been explored, with a case series demonstrating the complexities involved and the long-term neurodevelopmental outcomes for offspring (ref: Karataş doi.org/10.1016/j.wneu.2025.124631/). The multifraction Gamma Knife radiosurgery approach has also been scrutinized for its efficacy and associated risks, emphasizing the need for careful patient selection and monitoring (ref: Barzaghi doi.org/10.1227/ons.0000000000001842/). Additionally, strategies to prevent injury to the abducens nerve during retrosigmoid approaches have been developed, providing valuable guidance for improving surgical outcomes (ref: Torregrossa doi.org/10.3171/2025.6.JNS25604/).