Document Detail

Craniometric changes in patients with acromegaly from a surgical perspective.
MedLine Citation:
PMID:  20887128     Owner:  NLM     Status:  MEDLINE    
OBJECT: 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.
METHODS: 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.
RESULTS: Cranial vault thickness differed significantly (p < 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 cm3) and controls (10.06 ± 6.93 cm3).
CONCLUSIONS: 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.
Florian H Ebner; Verena Kürschner; Klaus Dietz; Eva Bültmann; Thomas Nägele; Juergen Honegger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgical focus     Volume:  29     ISSN:  1092-0684     ISO Abbreviation:  Neurosurg Focus     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896471     Medline TA:  Neurosurg Focus     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E3     Citation Subset:  IM    
Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany.
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MeSH Terms
Acromegaly / blood,  pathology*,  surgery*
Adenoma / pathology,  surgery
Cephalometry / statistics & numerical data*
Cone-Beam Computed Tomography / statistics & numerical data
Human Growth Hormone / blood
Insulin-Like Growth Factor I / analysis
Maxillary Sinus / pathology
Neurosurgical Procedures / methods
Pituitary Neoplasms / blood,  pathology,  surgery
Preoperative Care
Skull / pathology*,  surgery*
Sphenoid Sinus / pathology
Tomography, X-Ray Computed
Reg. No./Substance:
12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I

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