Advances in molecular and genetic profiling of meningiomas for improved diagnosis, prognosis, and targeted therapy

Background: Meningiomas exhibit substantial biological and clinical heterogeneity, and traditional histopathology alone often fails to accurately predict tumor behavior. Advances in molecular and genetic profiling have significantly enhanced diagnostic precision, prognostic assessment, and therapeutic decision-making. Methods: This review synthesizes current evidence on genomic, epigenomic, transcriptomic, and liquid biopsy-based approaches used to characterize meningiomas. Results: Key developments include characterization of NF2 and non-NF2 driver mutations, refinement of DNA methylation-based classification systems, identification of high-risk markers such as TERT promoter mutations and CDKN2A/B deletions, and the emergence of targeted therapeutic strategies. Liquid biopsy and circulating biomarkers further enable non-invasive disease monitoring and molecular risk stratification. Conclusion: Molecular profiling has transformed meningioma classification and risk prediction, supporting a shift toward precision neuro-oncology. Future progress will depend on integrated multi-omic diagnostics, improved biomarker-guided surveillance, and development of targeted therapeutic options for aggressive molecular subgroups.