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We analyze 293 tumors from patients aged 0\u201339 years using integrated histopathological and molecular profiling. Youth-onset meningiomas are enriched for\n                    <jats:italic>NF2<\/jats:italic>\n                    and\n                    <jats:italic>SMARCE1<\/jats:italic>\n                    alterations and exhibit a gain-dominated copy-number landscape, including recurrent chr17q gain, whereas canonical adult high-risk features, such as chr1p loss, lack prognostic significance. Adult-derived prognostic frameworks, including WHO grade, methylation-based stratification and integrated risk scores, fail to predict progression in patients \u226421 years of age. Tumors segregate into age-enriched epigenetic clusters defined by\n                    <jats:italic>SMARCE1<\/jats:italic>\n                    ,\n                    <jats:italic>NF2<\/jats:italic>\n                    and\n                    <jats:italic>BAP1<\/jats:italic>\n                    alterations. Among\n                    <jats:italic>NF2<\/jats:italic>\n                    -altered tumors, patterns of Merlin inactivation, shaped by germline status and co-occurring copy-number variations, delineate biologically divergent subsets. In patients \u226421 years, extent of resection is the dominant predictor of outcome, while molecular features further refine risk assessment. These findings define pediatric and young adult meningiomas as a distinct molecular entity and support age-adapted risk refinement that integrates molecular features with strong clinical determinants.\n                  <\/jats:p>","DOI":"10.1038\/s41467-026-75357-2","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:15:00Z","timestamp":1784034900000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinct molecular subgroups in pediatric and young-onset meningiomas require age-adapted risk stratification"],"prefix":"10.1038","volume":"17","author":[{"given":"Natalie","family":"Berghaus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnault","family":"Tauzi\u00e8de-Espariat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hielscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilan","family":"Savran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schrimpf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2117-6381","authenticated-orcid":false,"given":"Kirsten","family":"G\u00f6bel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Stutheit-Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7821-0282","authenticated-orcid":false,"given":"Lukas","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuat Kaan","family":"Aras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-1227","authenticated-orcid":false,"given":"Filippo","family":"Nozzoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0250-1696","authenticated-orcid":false,"given":"Dominik","family":"Sturm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5920-0029","authenticated-orcid":false,"given":"Christine L.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6677-3124","authenticated-orcid":false,"given":"Christian","family":"Mawrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1162-8771","authenticated-orcid":false,"given":"Julia E.","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6357-7227","authenticated-orcid":false,"given":"Till","family":"Acker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1109-915X","authenticated-orcid":false,"given":"Rudi","family":"Beschorner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Saribiyik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6179-2828","authenticated-orcid":false,"given":"Arda","family":"Inan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u00e7a","family":"Er\u015fen-Danyeli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9683-7494","authenticated-orcid":false,"given":"Mari\u00ebtte E. 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