Craniometric changes in patients with acromegaly from a surgical perspective

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this study was to evaluate and analyze morphometric and volumetric changes of the skull due to acromegaly in areas relevant for neurosurgical practice, focusing on the surgical implications.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>On preoperatively acquired CT scans, cephalometric and volumetric measurements were performed on 45 patients with acromegaly (Group A) and 45 control patients (Group B). The authors determined thickness of the cranial vault, inner and outer diameters of the skull, and the diameter of sphenoidal and maxillary sinus, as well as frontal and maxillary sinus volumetry. The morphometric and volumetric CT data of the patients with acromegaly were compared with the data of a control group and correlated with clinical parameters.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Cranial vault thickness differed significantly (p &lt; 0.0001) between the 2 groups. A correlation of the vault thickness with preoperative human growth hormone, insulin-like growth factor–I levels, and duration of clinical history in acromegaly could not be established. The outer anterior-posterior skull diameter of Group A (18.47 ± 0.94 cm) differed significantly (p = 0.0146) from Group B (17.98 ± 0.93 cm) and correlated significantly with preoperative human growth hormone (r = 0.3277; p = 0.0299) and insulin-like growth factor-–I serum levels (r = 0.3756; p = 0.0120). Measurements of the anterior-posterior diameter of the sphenoidal sinus differed significantly (p = 0.0074) between patients with acromegaly and controls. Volumetric analysis of the frontal sinus resulted in a statistically significant difference (p = 0.0382) between patients with acromegaly (14.89 ± 10.85 cm<jats:sup>3</jats:sup>) and controls (10.06 ± 6.93 cm<jats:sup>3</jats:sup>).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Significant craniometric changes and volumetric remodelling of the paranasal sinus occur in acromegaly. The bone alterations are of surgical importance for using the transsphenoidal approach. Detailed preoperative diagnostic examination and planning as well as selection of appropriate instruments are mandatory for safe and successful pituitary adenoma removal in patients with acromegaly.</jats:p></jats:sec>

Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor

“…10,11 Especially in the case of acromegalics undergoing TNTS, anatomic variations, namely, a deeper surgical corridor and a reduced intercarotid artery distance, have been previously reported. 8,[12][13][14] On the other hand, there is a paucity of data in the literature regarding anatomic variations in patients with Cushing disease. In any case, otolaryngologists and neurosurgeons who perform endoscopic skull base surgery should be aware of such anatomic variations and their implications for the surgical corridor, modifying their technique and approach as needed.…”

“…This dimension has been reported to be shorter in acromegalics, though the current study did not find a difference from controls. 8,14 On the other hand, sphenoid length seems to be decreased in Cushing disease patients (2.20 vs. 2.68 cm in controls). The more important technical point in consideration of sphenoid length is limiting the early-step sphenoidotomies to only the anterior face of the sphenoid sinus bilaterally.…”

Rate of rhinosinusitis and sinus surgery following a minimally destructive approach to endoscopic transsphenoidal hypophysectomy

“…Growth hormone–secreting tumors were more common than ACTH‐secreting tumors or prolactinomas in all groups. Anatomical changes associated with acromegaly and the resultant increased dissection and surgical difficulty may contribute to a predisposition for rhinosinusitis in these patients . Furthermore, Cushing's disease may lead to increased rates of comorbid obesity and diabetes mellitus, which can contribute to inflammation associated with chronic rhinosinusitis …”

Ct and Mri Evaluation of Skull Bones and Soft Tissues in Six Cats With Presumed Acromegaly Versus 12 Unaffected Cats

“…In people, chronic excess in GH and IGF‐1 results in maxillofacial deformities, including nasal bone hypertrophy, mandibular overgrowth, maxillary widening, frontal bossing, and temporomandibular remodeling . Soft tissue abnormalities of the head include sinonasal mucosal hypertrophy, tongue enlargement, and collapse of the lateral walls of the larynx.…”