Introduction and Aim: This article provides the latest evidence and recommendations regarding the management of patients with meningiomas before, during, and after surgery. Given the growing importance of multimodal approaches aimed at preserving patients neurological function and quality of life (QoL), it also examines the role of observation and radiation treatments, both as primary or adjuvant therapies.

Discussion: Various advancements in neurosurgery, such as the integration of the microscope and endoscope, enhanced preoperative neuroimaging, intraoperative image-guided techniques, and neurophysiological monitoring during surgery, have expanded the neurosurgeon’s capacity to address lesions previously deemed only partially removable or non-removable, while reducing associated risks. Conversely, preserving patients neurological function and quality of life has emerged as a paramount concern, surpassing complete tumor removal in significance for both patients and neurosurgeons. Within this context, stereotactic radiosurgery (SRS) and radiotherapy (RT) emerge as viable and safe options for asymptomatic smallto moderate-sized tumors showing growth on sequential imaging, or when used alongside planned partial tumor removal in critical areas. Although current data supporting pharmacotherapy for meningiomas are limited, the evidence base may strengthen in the near future with the identification of targetable mutations.

Conclusion: The primary goal in the management of meningiomas remains complete microsurgical resection, provided it can be accomplished with minimal or no adverse effects. Nonetheless, numerous studies have highlighted the safety and efficacy of stereotactic radiosurgery (SRS) or radiotherapy (RT) as viable treatments, either independently or in conjunction with surgery, particularly for meningiomas situated in critical locations (such as the cranial base) or in patients with underlying health issues or a preference for non-invasive interventions.