Bone CT evaluation of nasal cavity of acromegalics - Its morphological and surgical implication in comparison to non-acromegalics

Abstract

Purpose: In order to numerically compare the morphological differences of the nasal cavity and nasal sinus between acromegalics and non- acromegalics, bone window CT scans sliced parallel to the transsphenoidal surgical route were performed. Material and cases: Acromegalic patients had small or large macroadenomas and were 13 (7 men and 6 women) in number, aged 53.2+/-16.1 years. Non-acromegalic patients had pituitary tumors and were 44 (21 men and 23 women) in number, aged 52.1+/-12.5 years. Results. The results of acromegalics are described in comparison to non-acromegalics in parentheses. a) The width of the surgical corridor: piriform aperture, 27.6+/-2.7 (25.9+/-2.6) mm; origin of inferior nasal concha, 29.4+/-9.4 (26.6+/-4.0) mm; and origin of middle nasal concha, 29.8+/-3.2 (26.2 mm+/- 4.2) mm. b) The depth of the surgical corridor: the upper lip thickness, 18.1+/-2.7 (13.3+/-1.4) mm; the distances between piriform aperture and sphenoid wall, 52.9+/-4.6 (49+/-4.2) mm; sphenoid wall and sellar floor, 17.3+/-4.1 (18.7+/-4.1) mm; and sellar floor to dorsum sellae, 17.6+/-3.4 (15.6+/-4.0) mm. c). Marked carotid prominence: 7/13=53.4% (8/44=18.25%). d) Sinusitis: 8/13=61.5% (12/44=27.3%). Discussion and conclusion. The data presented above show that morphological differences in bony nasal cavity and soft tissue may be responsible for a deeper and narrower surgical field for acromegalics. Acromegalics had a marked carotid prominence more frequently, which needs special attention to avoid carotid injury, when enlarging the surgical field. Knowing these morphological differences will provide useful information for peri- and intra-operative care.