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Symptoms developed in 15.5%; 93.7% were treated (median time-to-treatment 1.06 years), with 5% recurrence. IMPACT groups stratified treatment-free (P\u2009&amp;lt;\u2009.0001) and symptom-free survival (P\u2009=\u2009.0007). Most meningiomas were molecularly low risk, although those from the hypermitotic DNA methylation group had higher IMPACT scores (P\u2009=\u2009.0020). Incidental meningiomas had distinct CNA and gene expression patterns and favorable outcomes compared to 1434 nonincidental meningiomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings support surveillance for most incidental meningiomas, but early treatment may improve outcomes for molecularly higher-risk cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuonc\/noag086","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T11:38:18Z","timestamp":1776339498000},"page":"1935-1950","source":"Crossref","is-referenced-by-count":4,"title":["Incidental meningiomas have favorable clinical outcomes across molecular classification systems"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9665-7629","authenticated-orcid":false,"given":"Minh P","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of California San Francisco , San Francisco, California,","place":["USA"]},{"name":"Department of Neurological Surgery, University of California San Francisco , San Francisco, California,","place":["USA"]},{"name":"Department of Pathology, University of California San Francisco , San Francisco, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7371-7059","authenticated-orcid":false,"given":"Kanish","family":"Mirchia","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of California San Francisco , San Francisco, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8924-5853","authenticated-orcid":false,"given":"William C","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of California San Francisco , San Francisco, California,","place":["USA"]},{"name":"Department of Neurological Surgery, University of California San Francisco , San Francisco, California,","place":["USA"]},{"name":"Department of Pathology, University of California San Francisco , San Francisco, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-6041","authenticated-orcid":false,"given":"Ramin A","family":"Morshed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California San Francisco , San Francisco, California,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-8864","authenticated-orcid":false,"given":"David R","family":"Raleigh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of California San Francisco , San 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