Anaplastic or malignant meningiomas (WHO Grade III) represent the most rare but aggressive subtype, accounting for 1-3% of all intracranial meningiomas. Due in large part to their scarcity, malignant meningiomas have been understudied and therefore represent an area where significant clinical advances may be made. To this point, our understanding of the genetic and histologic attributes of these lesions has grown, though the management and treatment of these aggressive tumors is less well elucidated and thus has room for further study. In this review, we describe the current understanding of malignant meningiomas in terms of their genetic alterations and unique histologic markers. Using this as a foundation, we will then discuss the current therapeutic strategies for managing these lesions and the future direction that such interventions may take.