Comprehensive Overview of Genetic Alterations in Meningioma

Meningiomas are the most common intracranial tumors in adult patients. According to the World Health Organization (WHO) criteria, meningiomas are classified into grades 1 to 3 for risk prediction purposes. The majority of meningiomas exhibit alterations in the NF2 gene, which encodes the merlin protein. Non-NF2-altered meningiomas often present alterations in genes such as TRAF7, KLF4, AKT1, SMO, POLR2A, and PIK3CA. Typically, these non-NF2 alterations occur in grade 1 meningiomas and are associated with specific anatomical locations, such as the skull base. More aggressive grade 2 and 3 meningiomas exhibit unique molecular alterations, including mutations in the TERT promoter region, the BAP1 gene, or alterations affecting the CDK pathway or SWI/SNF chromatin remodeling complex. This chapter provides a comprehensive review of these specific genetic alterations, contextualizing them within the WHO grading system and their anatomical locations.