Morphometric Changes in the Skull in Acromegalic Patients: Anatomical Perspective and Surgical Implications

Introduction: Acromegaly is a chronic endocrinopathy resulting from excessive growth hormone (GH) secretion leading to several body alterations, including morphological changes in skull and face. These modifications are of remarkable surgical interest, especially the increase of the working corridor length and the extensive paranasal sinus pneumatization.

Objective: The objective of this study was to describe and analyze morphometric changes of the skull and paranasal sinuses resulting from GH hypersecretion and describe findings that may be useful to skull base surgery planning and complication prediction.

Methods: Craniometric measurements were performed on 30 patients with acromegaly (Group A) and 30 control patients, with nonfunctional pituitary adenomas (Group B). Preoperative CT scans were used to evaluate cranial vault thickness; diameter of the skull and of the frontal, sphenoid, and maxillary sinuses; sphenoid sinus pneumatization patterns; and distance from vomer anterior limit to the dorsum sellae. Both groups were compared, and results were also correlated with hormonal and clinical data.

Results: Cranial vault thickness, diameter of the skull, and distance from vomer anterior limit to the dorsum sellae differed significantly (p < 0.005) between groups A and B. These findings also correlated considerably with preoperative growth hormone and insulin-like growth factor I serum levels. A correlation of the craniometric changes with the extent of clinical history in acromegalic patients could not be established.

Conclusion: Skull and paranasal sinuses alterations in acromegalic patients are of paramount importance when planning a skull base approach. The reported data may help surgeons to select the best working corridor, choose appropriate instruments, and anticipate complications for a safe and successful surgery.