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Transphenoidal surgery in acromegalic patients: anatomical considerations and potential pitfalls

  • Clinical Article - Neurosurgical Anatomy
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Abstract

Background

Transphenoidal surgery is an effective treatment for acromegalic patients with growth hormone (GH) producing pituitary adenomas. Since acromegaly is a systemic disease which causes multiple bony alterations, we hypothesized that it could affect the sphenoid sinus anatomy. The aim of the study was to determine whether acromegalic patients have sphenoid sinus alterations with potential surgical impact.

Methods

Fourty-six consecutive patients (23 acromegalics-GH group, 23 non-acromegalics-nGH group) undergoing transphenoidal surgery were included in this study. Pre-operative volumetric CT scan of the head was used to assess the following anatomic characteristics: type of sphenoid sinus (sellar, pre-sellar, conchal); number of intrasphenoid septa; number of carotid-directed septa; intercarotid distance; depth of the sphenoid sinus; depth and size of the sella.

Results

The sphenoid sinus was of the pre-sellar/conchal type in 26 % of the patients with acromegaly (n = 23) versus 9 % of the patients of the nGH group (n = 23). The number of intrasphenoid septations was significantly higher in the GH group than in the nGH group (P = .03). Interestingly, the intercarotid distance was smaller in GH patients than in nGH displaying a trend toward significance (P = .05). The sphenoid bone was deeper in the GH group as compared to the nGH group (P = .01) but the distance sphenoid sinus-sella was reduced (P < .01). Finally, the sella was not deeper, nor larger in acromegalic patients.

Conclusions

The sphenoid sinus of acromegalic patients resulted in being deeper, characterized by more septa and by a reduced intercarotid distance. These alterations deserve special pre- and intraoperative care, being potentially responsible for surgical difficulties.

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Acknowledgments

The authors would like to thank Dr. Valeria Conte for assistance in the statistical analysis.

Ethical standards

The authors declare that this work met all ethical standards for research and scientific publication.

Conflicts of interest

None.

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Authors and Affiliations

  1. Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milano, Via Francesco Sforza 35, 20122, Milano, MI, Italy

    Giorgio Carrabba, Marco Locatelli, Luca Mattei, Paolo Rampini & Sergio Maria Gaini

  2. Otorhinolaryngology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milano, Milano, Italy

    Claudio Guastella

  3. Endocrinology and Diabetology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milano, Milano, Italy

    Giovanna Mantovani

Authors
  1. Giorgio Carrabba
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  2. Marco Locatelli
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  3. Luca Mattei
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  4. Claudio Guastella
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  5. Giovanna Mantovani
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  6. Paolo Rampini
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  7. Sergio Maria Gaini
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Corresponding author

Correspondence to Giorgio Carrabba.

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Comment

The authors have performed an interesting study comparing the nasal anatomy of acromegalic patients compared with nonfunctional pituitary adenoma patients. They note differences in anatomy of the sphenoid (deeper in acromegalics), intercarotid distance, and number of intrasphenoid septations.

While some of the measures, such as intercarotid distance), approached statistical significance, one would anticipate that this would be true with larger comparison group size (small“n”). Such observations have been noted by other authors. In fact our own group has recently noted that the carotid artery is actually larger in the cavernous segment in acromegalic patients than non growth-hormone secreting controls, which may account for some of the reduction in intracarotid distance (manuscript submitted).

All of these observations are important for the pitutary surgeon in the safe management of these patients, especially the reduced intercarotid distance which may increase chances of carotid injury during the surgery.

W.T.Couldwell

Utah, USA

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Carrabba, G., Locatelli, M., Mattei, L. et al. Transphenoidal surgery in acromegalic patients: anatomical considerations and potential pitfalls. Acta Neurochir 155, 125–130 (2013). https://doi.org/10.1007/s00701-012-1527-6

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  • DOI: https://doi.org/10.1007/s00701-012-1527-6

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