Abstract
High-grade meningiomas have a persistent therapeutic challenge, which the World Health Organization (WHO) categorizes as grade II and III lesions, represent 10–20% and 5% of individuals with meningiomas, respectively. Although grade I meningiomas can be completely surgically removed and have long-term progression-free survival, higher grade meningiomas are more likely to return aggressively and to be resistant to conventional treatments. Recently, stereotactic radiosurgery (SRS) has offered promise for the treatment of localized tumors. The era of molecular targeted treatment is now upon us. Patients are being enrolled in clinical trials with a variety of innovative medications that target driver mutations, and these trials might result in more effective treatment plans. Alpha-interferon, vascular endothelial growth factor inhibitors, and somatostatin receptor agonists are among the medications that are advised for the medical treatment of meningiomas in addition to radiation and surgical excision. For the treatment of meningioma, efforts to find novel informative mutations and protein biomarkers have advanced. Several patient populations have shown promise for improved outcomes with EZH2 inhibition. Overall, it is hoped that targeted research and the application of those strategies, such as PRRT and TTF devices, would lead to better results in future. This chapter aims to discuss the neuroimaging features of high grade meningiomas, diagnostic and therapeutic implications of recently discovered genetic alterations and outcome. There will be a brief review focusing on ongoing clinical trials of novel therapeutic agents and future research scope in this arena.