[Meningioma Management in the Era of Molecular Classification:From Risk Stratification to Personalized Treatment]

Meningiomas have traditionally been classified and treated according to histopathological grade and extent of resection. However, recent advances in molecular biology have revealed that histology alone does not fully explain the clinical behavior of these tumors. The 2021 World Health Organization classification introduced molecular criteria for meningioma grading, including CDKN2A/B homozygous deletion and TERT promoter mutation as defining features of grade 3 disease. In parallel, large-scale multi-omics studies integrating genomic, epigenomic, and transcriptomic data have established biologically and clinically meaningful molecular subgroups. These findings indicate that copy number alterations, including 22q loss, 1p loss, and 1q gain, may provide practical markers for risk stratification in daily practice. Molecular profiling is also beginning to refine therapeutic decision-making, including the role of surgery, radiotherapy, and systemic treatment. Emerging approaches such as molecular targeted therapy, radioligand therapy, immune checkpoint inhibition, and CDK pathway inhibition suggest a transition from conventional grade-based management toward precision medicine. This review summarizes recent progress in the molecular classification and personalized treatment of meningiomas.