Craniopharyngiomas pose a challenge in their neurosurgical treatment. Operative removal may cause serious endocrinological, ophthalmological or rhinological deficits. The novel chemotherapeutic inhibition of the BRAF V600E mutation in craniopharyngiomas shows promising early results. Here we retrospectively analysed our postoperative outcome data with a focus on this mutation.
Our workgroup recently performed an outcome analysis of craniopharyngioma patients surgically treated in our department (Marx et al, 2021). In this study we compared the radiological, endocrinological, ophthalmological and rhinological data between patients with (N=9) and without (N=14) this particular mutation.
The BRAF V600E mutation was present in 9 individuals´ tumor tissue (39.1%) The mean follow-up period was 58 (M) vs. 74 (WT) months. The mean surgical duration was 405 (M) vs. 440 (WT) minutes, range: 352-527. The infiltrated pituitary stalk had to be removed in 22.2% (M) and 42.9% (WT). Consecutive surgical and/or adjuvant treatment was necessary in 25.0% (M) and 40.0% (WT). Among the wild type cases, 3 individuals underwent late revision surgery, another patient had 3 operations. Two of the mutated tumors were revised surgically. Complications occurred in 55.5% (M) and 50.0% (WT).
We observed a deterioration of the mostly already impaired adrenocorticotropic, thyreotropic and gonadotropic axes in 51.7% and the somatotropic in 43.9%, respectively (M). Diabetes insipidus persisted in 43.9% with one remission (M).
Comparison analyses focusing on the BRAF V600E mutation showed no significant differences from the aspects of gender, age, BMI, surgical duration, rate of persisting symptoms, intraoperative extent of tumor resection, recidive rate, necessity of adjuvant therapy, complications. QOL was comparable according to ASBQ and SNOT. The trends of the pituitary axis function were similar. The trends of visual acuity and perimetry were also without relevant differences.
This study suggests no connection between BRAF V600E mutation status, QOL and various patient data. Future targeted oncological therapy based may improve the outcome results of craniopharyngioma patients, underlining the necessity of large scale analyses.