Intratumoral heterogeneity and <i>TERT</i> promoter mutations in progressive/higher-grade meningiomas

In progressive/higher-grade meningiomas,<i>TERT</i>p mutations are associated with poor survival, supporting a model in which selection of this alteration is a harbinger of aggressive tumor development. In addition, we observe spatial intratumoral heterogeneity of <i>TERT</i>p mutation status, consistent with this model of late emergence in tumor evolution. Thus, early detection of <i>TERT</i>p mutations may define patients with more aggressive meningiomas. Stratification for <i>TERT</i> alterations should be adopted in future clinical trials of progressive/higher-grade meningiomas.