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In meningiomas, MIB-1 correlates with recurrence, with a proposed 4.1% cutoff. This study aimed to identify optimal patient groups for the MIB-1 proliferation index threshold, hypothesizing improved recurrence prediction within stratified subgroups. We performed a retrospective cohort study of adult patients (\u2265\u200918 years) undergoing primary meningioma resection (2005\u20132018) with available MIB-1 proliferation index and at least five years of MRI follow-up. Meningiomas of all WHO grades were included. Of 505 patients (median age 59 years) meeting inclusion criteria, 340 (67.3%) were female, with meningiomas predominantly WHO grade I (55.8%) or II (41.6%). subtotally resected (STR) WHO grade I meningiomas account for a total of 58 (20.6%) cases out of all 282 (GTR\u2009+\u2009STR) surgically treated grade I meningiomas. Of these 58 STR grade I meningiomas, 21 (36%) recurred within the 5-year follow-up period. Among 35 subtotally resected grade I meningiomas with MIB-1 values of \u2264\u20094%, only four (11%) recurred in five years. In the multivariable analysis, preoperative meningioma volume ((\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02, HR 1.02) per 1 cm\n                    <jats:sup>3<\/jats:sup>\n                    increase) and 4% cutoff for MIB-1 ((\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02, HR 3.9) remained significant with respect to 5-year recurrence. Consistent with prior studies, the MIB-1 index of 4% seems to identify a subgroup of meningioma patients with low risk of recurrence. MIB-1 is likely to offer utility especially in designing individualized and less frequent imaging follow-up strategies after resection of WHO grade I meningiomas, where molecular genetics are not defined routinely.\n                  <\/jats:p>\n                  <jats:p>Clinical trial number: not applicable.<\/jats:p>","DOI":"10.1007\/s10143-026-04345-3","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:28:58Z","timestamp":1781159338000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MIB-1 index predicts low recurrence risk after subtotal resection of meningiomas: a retrospective study of 505 patients"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1078-4718","authenticated-orcid":false,"given":"Joonas","family":"Laajava","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8786-3827","authenticated-orcid":false,"given":"Jenni","family":"M\u00e4\u00e4tt\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4463-6954","authenticated-orcid":false,"given":"Miikka","family":"Korja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"4345_CR1","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.2217\/fon-2018-0006","volume":"14","author":"RA Buerki","year":"2018","unstructured":"Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV (2018) An overview of meningiomas. 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Because the data were anonymized and collected retrospectively, obtaining individual informed consent was not feasible. In accordance with local regulations and institutional policy, the institutional review board reviewed the project and waived the requirement for separate ethics approval and informed consent. The study was conducted in accordance with the Declaration of Helsinki and applicable data-privacy laws.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The need for written informed consent was not required, as patients were pseudonymized and could not be identified. Due to anonymization obtaining consent was not feasible.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}],"article-number":"444"}}