Effect of Extent of Resection and Adjuvant Radiation on Recurrence Rate of BRAF versus Beta-Catenin-Mutated Craniopharyngioma

Background: Craniopharyngiomas (CPs) are often densely adherent to critical structures in the suprasellar and parasellar space and attempts at gross total resection (GTR) pose a risk of neurological morbidity. The two histologic subtypes of CP—papillary and adamantinomatous—harbor mutually exclusive mutations of BRAF V600E and CTNNB1 mutations, respectively. Historical studies predating the era of endoscopic endonasal surgery have suggested that subtotal resection (STR) plus adjuvant radiation therapy (XRT) may result in similar progression-free survival (PFS). In this study, we aimed to test the hypothesis that STR ± XRT and GTR result in similar progression-free survival for both BRAF and CTNNB1 (β-catenin)-mutated CPs.