Meningioma in the modern era: Updates in stratification and therapeutic approaches

Abstract

Meningioma is the most common primary intracranial tumor in adults. Most meningiomas have an indolent growth pattern, but some can grow quickly. The World Health Organization (WHO) classification system is the gold standard for tumor grading and relies predominantly on histopathology and limited molecular alterations. It is increasingly recognized that the variability in tumor behaviour is incompletely captured using traditional systems. Contemporary advances have expanded tumor stratification beyond starting WHO grading, providing a more comprehensive framework for understanding tumor biology. Molecular profiling has identified independent biological classification systems and molecular signatures that capture important prognostic information beyond histopathology. Magnetic resonance imaging-based analyses and radiomics have enabled non-invasive characterization of tumor phenotype and growth potential. Therapeutically, surgical resection and radiation therapy remain the foundation of management, with evolving paradigms emphasizing maximal safe resection and risk-adapted radiotherapy strategies informed by integrated tumor characteristics. Systemic therapies have historically shown limited efficacy; however, recent efforts are shifting toward biomarker-driven, precision approaches guided by molecular alterations. Future directions focus on integrating multimodal data into unified, clinically actionable models that more accurately predict recurrence, progression, and treatment response. Such approaches aim to move beyond parallel classification systems toward individualized management strategies, ultimately advancing meningioma care into a precision-based paradigm.