Fusiform dilatation of the cavernous carotid artery in acromegalic patients
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CLINICAL ARTICLE - BRAIN TUMORS
Fusiform dilatation of the cavernous carotid artery in acromegalic patients Walavan Sivakumar & Roukoz B. Chamoun & Jay Riva-Cambrin & Karen L. Salzman & William T. Couldwell
Received: 4 January 2013 / Accepted: 21 March 2013 / Published online: 16 April 2013 # Springer-Verlag Wien 2013
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. W. Sivakumar : R. B. Chamoun : J. Riva-Cambrin : W. T. Couldwell Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA K. L. Salzman Department of Radiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA W. T. Couldwell (*) Department of Neurosurgery, University of Utah, 175 N. Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA e-mail: [email protected]
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
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