Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor

Area of Science:

• Otorhinolaryngology
• Neurosurgery
• Endocrinology

Background:

• Functioning pituitary adenomas cause endocrinopathies like acromegaly and Cushing syndrome.
• These hormonal imbalances lead to characteristic soft tissue deposition and anatomical changes.

Purpose of the Study:

• To evaluate and compare anatomical differences in the skull base and sinonasal region between patients with acromegaly, Cushing disease, and healthy controls.
• To inform surgical approaches for pituitary adenomas.

Main Methods:

• Radiographic review of preoperative MRI scans from 30 acromegaly patients, 31 Cushing disease patients, and 15 controls.
• Assessment of specific dimensions including piriform aperture width, sphenoid sinus dimensions, and nasal cavity height.

Main Results:

• Both acromegaly and Cushing disease patients showed wider piriform apertures and increased distance from the piriform aperture to the anterior sphenoid face compared to controls.
• Acromegaly patients had a less acute angle between the anterior nasal spine and sphenoid.
• Cushing disease patients exhibited shorter sphenoid sinus length and nasal cavity height.

Conclusions:

• Significant anatomical variations exist in the skull base and sinonasal anatomy of acromegaly and Cushing disease patients.
• Skull base surgeons must be aware of these differences to adapt transsphenoidal surgical techniques.
• Understanding these variations can optimize surgical outcomes and patient safety.