title: Fusiform dilatation of the cavernous carotid artery in acromegalic patients.
abstract: BACKGROUND
  Surgeons undertaking transsphenoidal surgery in patients with acromegaly confront multiple unique challenges secondary to the anatomic alterations caused by growth hormone-secreting tumors. The senior author has noted a fusiform dilatation of the cavernous carotid artery in many acromegalic patients. The authors aim to quantify this dilatation and correlate it with potential contributing factors.
  
  
  METHODS
  Clinical and radiographic data were retrospectively assessed in acromegalic patients undergoing transsphenoidal surgery from 2000 through 2011. Randomly selected patients with nonsecreting pituitary adenomas were used as the control cohort. Demographic information, comorbidities, and preoperative growth hormone and insulin-like growth factor-1 levels were recorded. Magnetic resonance (MR) imaging variables included tumor size, diameters of the petrous, cavernous, and supraclinoid segments of the carotid artery, and extent and location of cavernous sinus invasion. Independent correlations between acromegaly and each variable were assessed with multivariate regression analysis.
  
  
  RESULTS
  Forty randomly selected patients with growth hormone-secreting adenomas who underwent surgery and had MR imaging with thin coronal slices of the pituitary region were enlisted in our study cohort. The mean age was 45.7 years. Forty-two males (52.5 %) were included in the study. Mean carotid artery diameter measurements for acromegalic and control patients, respectively, were 4.2 vs. 3.8 mm (petrous carotid), 5.0 vs. 4.0 mm (cavernous carotid), and 3.3 vs. 2.9 mm (supraclinoid carotid). Multivariate analysis showed only age and cavernous carotid diameter were statistically significant independent variables (p = 0.02, p < 0.001, respectively). Age, tumor size, growth-hormone or insulin-like growth factor-1 levels, and cavernous sinus invasion did not correlate with cavernous carotid artery diameter.
  
  
  CONCLUSIONS
  In patients with acromegaly, there is a fusiform dilatation of the cavernous carotid artery that must be considered when planning transsphenoidal surgery.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: Walavan
authors.initials: W
authors.lastname: Sivakumar
authors.forename: Roukoz B
authors.initials: RB
authors.lastname: Chamoun
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: Karen L
authors.initials: KL
authors.lastname: Salzman
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
mesh_terms: D000172:Acromegaly / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D002343:Carotid Artery, Internal / Q000473:pathology*; D004106:Dilatation / Q000379:methods; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D010911:Pituitary Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone