Multidisciplinary management of meningiomas in the era of precision oncology.

This review article provides an up‑to‑date, integrated overview of meningioma biology, diagnosis, and management, emphasizing how evolving molecular, imaging, and therapeutic tools are reshaping care.

Key points:

• Epidemiology and classification
  • • Meningiomas are the most common primary intracranial tumors.
  • • Histopathologic WHO grading is still the clinical standard for risk stratification and treatment planning in most centers.
  • • Molecularly informed classification systems have emerged that improve prognostic accuracy beyond histology alone and have potential to guide more personalized management, though they are not yet fully standardized or universally adopted.
• Imaging advances
  • • Somatostatin receptor–targeted PET‑CT and MRI improve tumor delineation compared with conventional imaging.
  • • These modalities support earlier detection of residual or recurrent disease and can aid precision planning for local therapies, including surgery and radiotherapy.
• Local therapy
  • • Surgery and radiotherapy remain the backbone of treatment.
  • • Advances in endoscopic and other minimally invasive neurosurgical techniques have enabled safer resections, particularly for tumors in complex skull base locations.
  • • Modern stereotactic radiotherapy platforms allow more conformal dosing, with the goal of better local control while limiting toxicity.
• Systemic and novel therapies
  • • There is growing use and investigation of systemic agents, including:
  • • Targeted therapies,
  • • Immune checkpoint inhibitors,
  • • Somatostatin receptor–directed radioligand therapies.
  • • These options are increasingly considered for patients with recurrent, progressive, or otherwise difficult‑to‑treat meningiomas.
• Ongoing challenges and research directions
  • • Need for harmonized, clinically practical classification systems that integrate histologic and molecular features.
  • • Development and validation of predictive biomarkers to select patients for specific systemic and radioligand therapies.
  • • Optimization of clinical trial design in a heterogeneous disease with variable natural history and relatively low incidence of high‑grade cases.

Overall, the article proposes a contemporary roadmap for meningioma care, from diagnosis through treatment selection, and outlines priority areas for future translational and clinical research.