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Entering a new era of molecular oncology, exosomes\u2014nanoscale extracellular vesicles\u2014have emerged as master regulators of intercellular communication, dynamically sculpting the glioma tumor microenvironment (TME) and orchestrating hallmarks of malignancy, including immune evasion, angiogenesis, and therapeutic resistance. These versatile vesicles transport bioactive cargo (e.g., miRNAs, lncRNAs, proteins) to reprogram stromal, neuronal, and immune cells, creating a permissive niche for tumor progression. Recent breakthroughs now position exosomes at the forefront of translational medicine, serving dual roles as minimally invasive biomarkers and engineered nanovectors for precision therapy. This review systematically deciphers how exosomes fuel glioma pathogenesis\u2014from driving macrophage polarization and T\u2010cell suppression to facilitating blood\u2010brain barrier disruption and chemoresistance. Beyond mechanistic insights, we spotlight pioneering strategies harnessing exosomes for drug delivery, immunotherapy, and nanotechnology\u2010driven interventions. By bridging foundational discoveries with clinical applications, this work heralds a new era in glioma management, where exosome\u2010based tools promise to revolutionize personalized diagnosis, prognostication, and therapeutic innovation.<\/jats:p>","DOI":"10.1002\/smll.73721","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T11:02:01Z","timestamp":1780138921000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exosomes in Glioma: Integrating Molecular Mechanisms with Diagnostic and Therapeutic Potential"],"prefix":"10.1002","volume":"22","author":[{"given":"Yantong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Xiangya Hospital Central South University  Changsha China"},{"name":"Xiangya School of Medicine Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingdi","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Xiangya Hospital Central South University  Changsha China"},{"name":"Xiangya School of Medicine Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-2556","authenticated-orcid":false,"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Second Affiliated Hospital Chongqing Medical University  Chongqing China"},{"name":"Western Institute of Digital\u2010Intelligent Medicine  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wantao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery The Second Affiliated Hospital Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Life Science and Technology Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-4617","authenticated-orcid":false,"given":"Zhiwei","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology Hunan Aerospace Hospital Hunan Normal University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Hunan University of Medicine General Hospital  Huaihua China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8215-2045","authenticated-orcid":false,"given":"Peng","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Oncology Zhujiang Hospital Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2401-5349","authenticated-orcid":false,"given":"Quan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Xiangya Hospital Central South University  Changsha China"},{"name":"Western Institute of Digital\u2010Intelligent Medicine  Chongqing China"},{"name":"Department of Neurosurgery Xiangya School of Medicine Central South University  Changsha China"},{"name":"Department of Neurosurgery Xiangya Hospital Jiangxi. 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