手术切除长期以来一直是治疗脑膜瘤的首选方法，而且在很多情况下被认为是治愈的。事实上，切除范围是确定疾病复发和优化患者手术结果的重要因素。尽管辛普森分级仍然被广泛接受作为切除范围的衡量标准，并且用于预测症状复发，但是它的效用正受到越来越多的审视。随着我们对脑膜瘤生物学的认识迅速发展，手术在脑膜瘤的确定性治疗中的作用正在被重新评估。尽管在历史上被认为是“良性”病变，但是脑膜瘤的自然史可能差异很大，表现为意外高的复发率和生长速度，并且不一定与其WHO分级相符。经组织学证实的WHO I级肿瘤可能表现出意外的复发、恶性转化和侵袭性行为，突显了分子复杂性和异质性。随着我们对基因组和表观基因组因素临床预测能力的理解不断提高，我们在这里讨论了在这些分子特征快速发展的背景下的手术决策范式的重要性。 ©2023年。作者。

Surgical resection has long been the treatment of choice for meningiomas and is considered curative in many cases. Indeed, the extent of resection (EOR) remains a significant factor in determining disease recurrence and outcome optimization for patients undergoing surgery. Although the Simpson Grading Scale continues to be widely accepted as the measure of EOR and is used to predict symptomatic recurrence, its utility is under increasing scrutiny. The influence of surgery in the definitive management of meningioma is being re-appraised considering the rapid evolution of our understanding of the biology of meningioma.Although historically considered "benign" lesions, meningioma natural history can vary greatly, behaving with unexpectedly high recurrence rates and growth which do not always behave in accordance with their WHO grade. Histologically confirmed WHO grade 1 tumors may demonstrate unexpected recurrence, malignant transformation, and aggressive behavior, underscoring the molecular complexity and heterogeneity.As our understanding of the clinical predictive power of genomic and epigenomic factors matures, we here discuss the importance of surgical decision-making paradigms in the context of our rapidly evolving understanding of these molecular features.© 2023. The Author(s).