title: Craniometric changes in patients with acromegaly from a surgical perspective.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany. florianebner@virgilio.it
authors.forename: Florian H
authors.initials: FH
authors.lastname: Ebner
authors.forename: Verena
authors.initials: V
authors.lastname: Kürschner
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Eva
authors.initials: E
authors.lastname: Bültmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Nägele
authors.forename: Juergen
authors.initials: J
authors.lastname: Honegger
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D002508:Cephalometry / Q000706:statistics & numerical data*; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008443:Maxillary Sinus / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods; D010911:Pituitary Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D012886:Skull / Q000473:pathology* / Q000601:surgery*; D013101:Sphenoid Sinus / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I