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Fusiform dilatation of the cavernous carotid artery in acromegalic patients

  • Clinical Article - Brain Tumors
  • Published:
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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.

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Acknowledgments

The authors thank Kristin Kraus, M.Sc., for her steadfast assistance in the preparation of this article and Jennie Swensen, M.A., for her medical illustration.

Conflicts of interest

None.

Author contribution

Conception and design: Couldwell, Chamoun, Sivakumar. Acquisition of data: Chamoun, Salzman, Sivakumar. Analysis and interpretation of data: Couldwell, Riva-Cambrin, Chamoun, Sivakumar. Drafting the article: Sivakumar. Critically revising the article: all authors. Reviewed submitted version of the manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Couldwell. Statistical analysis: Riva-Cambrin, Sivakumar. Study supervision: Couldwell.

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Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

    Walavan Sivakumar, Roukoz B. Chamoun, Jay Riva-Cambrin & William T. Couldwell

  2. Department of Radiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

    Karen L. Salzman

  3. Department of Neurosurgery, University of Utah, 175 N. Medical Drive East, 5th Floor, Salt Lake City, UT, 84132, USA

    William T. Couldwell

Authors
  1. Walavan Sivakumar
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  2. Roukoz B. Chamoun
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  3. Jay Riva-Cambrin
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  4. Karen L. Salzman
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  5. William T. Couldwell
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Corresponding author

Correspondence to William T. Couldwell.

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Comment

This is an interesting paper, but of course without a conclusion as to why these tumours should cause dilatation. I was frankly surprised that neither hypertension nor, particularly, diabetes was more prevalent as our acromegalics are definitely more often diabetic and, I thought, hypertensive. Perhaps this is a phenomenon of healthy Utah.

I would be interested if this same study could be done on your Cushing's patients, which I understand is in preparation. Perhaps this will give the answer.

The message—surgeon beware the carotid in acromegalics—is a useful reminder.

Michael Powell

London, UK

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Sivakumar, W., Chamoun, R.B., Riva-Cambrin, J. et al. Fusiform dilatation of the cavernous carotid artery in acromegalic patients. Acta Neurochir 155, 1077–1083 (2013). https://doi.org/10.1007/s00701-013-1691-3

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  • DOI: https://doi.org/10.1007/s00701-013-1691-3

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