Multidisciplinary management of meningiomas in the era of precision oncology

Meningiomas are the most common type of primary intracranial tumour. Histopathology-based WHO grading remains the standard for guiding management in most institutions, although new molecularly driven classification tools have been shown to improve prognostic accuracy and could guide personalized management decisions. Somatostatin receptor-targeted PET-CT or MRI has improved tumour delineation, enabling earlier diagnosis of residual or recurrent disease and guiding precision delivery of local therapies. Patients with meningioma have been traditionally managed with surgery and radiotherapy, although advances over the past decade have brought about promising novel treatment options. These developments include endoscopic surgery and other forms of minimally invasive surgery that have enabled safer resections, stereotactic radiotherapy platforms and systemic treatment with targeted agents, immune checkpoint inhibitors and targeted radioligands, which are being increasingly considered for patients with meningioma. Despite these advances, challenges remain, particularly in the standardization of classification systems, development of predictive biomarkers and optimization of trial designs. In this comprehensive, state-of-the-art Review we provide an integrated roadmap for meningioma care as well as a framework for ongoing and future research in this field.