Do you routinely obtain a biopsy of a presumed meningioma prior to SRS to confirm grade 1?

There is an emerging and growing body of data using various AI tools and radiomics analysis, as well as the incorporation of advanced imaging, that aim to improve the ability to predict the grade of meningioma. Most of this work remains "limited institution" in terms of applicability. In the current era, we obtain PET imaging with DOTATATE on nearly all meningioma patients, even those selected for SRS. The key issue here is how to select patients for SRS. The lesions should be small, unresectable, with evidence of slow growth, "hot" on DOTATATE PET, not in locations which would compromise SRS dose or risk unnecessary OAR toxicities, and having undergone multidisciplinary review to rule out obvious things like dural-based mets, other confoun...