Resolution of Chiari malformation after treatment of acromegaly

Ammerman, Joshua M.; Goel, Rishi; Polin, Richard S.

doi:10.3171/jns.2006.104.6.980

Cited by 11 publications

(15 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An association of acromegaly and Chiari malformation has been reported in the literature. 1,2,8 A hypothesis for this association might be that the bony overgrowth reduces posterior fossa volume. 2 At least supratentorially, we could not confirm this phenomenon: both the outer anterior-posterior and lateral-lateral skull diameters increased but not the corresponding inner diameters, thus the intracranial volume itself does not appear to diminish.…”

Section: Discussionmentioning

confidence: 99%

Craniometric changes in patients with acromegaly from a surgical perspective

Ebner¹,

Kürschner²,

Dietz

et al. 2010

FOC

View full text Add to dashboard Cite

Object The objective of this study was to evaluate and analyze morphometric and volumetric changes of the skull due to acromegaly in areas relevant for neurosurgical practice, focusing on the surgical implications. Methods On preoperatively acquired CT scans, cephalometric and volumetric measurements were performed on 45 patients with acromegaly (Group A) and 45 control patients (Group B). The authors determined thickness of the cranial vault, inner and outer diameters of the skull, and the diameter of sphenoidal and maxillary sinus, as well as frontal and maxillary sinus volumetry. The morphometric and volumetric CT data of the patients with acromegaly were compared with the data of a control group and correlated with clinical parameters. Results Cranial vault thickness differed significantly (p < 0.0001) between the 2 groups. A correlation of the vault thickness with preoperative human growth hormone, insulin-like growth factor–I levels, and duration of clinical history in acromegaly could not be established. The outer anterior-posterior skull diameter of Group A (18.47 ± 0.94 cm) differed significantly (p = 0.0146) from Group B (17.98 ± 0.93 cm) and correlated significantly with preoperative human growth hormone (r = 0.3277; p = 0.0299) and insulin-like growth factor-–I serum levels (r = 0.3756; p = 0.0120). Measurements of the anterior-posterior diameter of the sphenoidal sinus differed significantly (p = 0.0074) between patients with acromegaly and controls. Volumetric analysis of the frontal sinus resulted in a statistically significant difference (p = 0.0382) between patients with acromegaly (14.89 ± 10.85 cm3) and controls (10.06 ± 6.93 cm3). Conclusions Significant craniometric changes and volumetric remodelling of the paranasal sinus occur in acromegaly. The bone alterations are of surgical importance for using the transsphenoidal approach. Detailed preoperative diagnostic examination and planning as well as selection of appropriate instruments are mandatory for safe and successful pituitary adenoma removal in patients with acromegaly.

show abstract

Section: Discussionmentioning

confidence: 99%

Craniometric changes in patients with acromegaly from a surgical perspective

Ebner¹,

Kürschner²,

Dietz

et al. 2010

FOC

View full text Add to dashboard Cite

show abstract

“…e authors found nine similar cases in of the literature; notably, these combined pathologies further contributed to posterior fossa bony hypertrophy and increased narrowing of the foramen magnum [Table 1]. [1,2,[4][5][6][7][8] Most cases with CM1 and acromegaly first received treatment for the pituitary lesion. [3] However, in our case, the patient first required a posterior fossa decompression/C1 laminectomy followed by medical management of the pituitary lesion.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Chiari type 1 malformation associated with acromegaly: A case report

Aoki

Umebayashi

Tatsuzawa

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

Background: Here, we report a patient who presented with both symptomatic acromegaly and symptomatic Chiari I malformation (CM1) with a C2-T5 syrinx. Case Description: A 63-year-old female presented with bilateral arm dysesthesias and back pain. For approximately the past 30 years, she had chronic signs of acromegaly (i.e. an enlarged forehead, jaw, and nose, and enlarged hands and feet). When the cervical magnetic resonance showed a CM1 (tonsillar herniation) with C2-T5 syringomyelia, she underwent foramen magnum decompression and C1 posterior arch resection. Postoperatively, she was asymptomatic. The added finding of a growth hormone (GH)-producing pituitary lesion was treated medically with endocrine therapy, as she had incidentally required surgery/chemotherapy for a newly diagnosed colon cancer. Conclusion: Symptomatic CM1, syrinx, and acromegaly may occur together. Appropriately treatment may include a suboccipital decompression, and C1 arch resection surgery, followed by either surgical or medical treatment for the GH-producing pituitary adenoma.

show abstract

“…The CTH rate was also significantly higher than in control group 1, despite the fact that the latter, due to the selection criteria (patients presenting with headache or transient neurological deficit), was expected to have a higher prevalence than in healthy subjects. Until now, four case reports of CTH in acromegaly patients [11][12][13][14] have been published with some authors suggesting a possible relationship between GH excess and cerebellar tonsil herniation. In a series of 741 patients with CM1, Milhorat et al [15].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…A few cases of acromegaly patients with concomitant CTH have been reported [11][12][13][14][15]. The coexistence has been considered incidental by some authors [13,] while others have hypothesized a direct relationship with GH/IGF-1 excess [11,12,14]. Cranial constriction due to soft and/or bony tissue hypertrophy has been proposed as a possible pathogenic explanation, since acromegaly patients show progressive facial and skull bony deformities; however, direct evidence of significant changes in posterior fossa size is lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact

et al. 2012

View full text Add to dashboard Cite

Herniation of cerebellar tonsils (CTH) might occur in acromegaly patients and improve after acromegaly treatment. Our study investigated CTH prevalence in acromegaly, its relationship with clinical, laboratory and neuroimaging findings and its possible pathogenesis and clinical impact. 150 acromegaly patients (median-age 56 years, age-range 21-88, 83 females) underwent brain magnetic resonance imaging (MRI). Clinical data, laboratory and pituitary adenoma imaging findings were recorded. CTH, posterior cranial fossa area, tentorial angle, clivus, supraocciput and Twining's line length were measured in acromegaly patients and controls, who included MRI of 115 consecutive subjects with headache or transient neurological deficits (control group-1) and 24 symptomatic classic Chiari 1 malformation patients (control group-2). Acromegaly patients were interviewed for symptoms known to be related with CTH. 22/150 acromegaly patients (15 %) and 8/115 control group-1 subjects presented with CTH (p = 0.04). In acromegaly patients, CTH correlated positively with younger age and inversely with GH-receptor antagonist treatment. Control group-2 had a shorter clivus than CTH acromegaly patients (40.4 ± 3.2 mm vs 42.5 ± 3.3 mm, p < 0.05), while posterior fossa measures did not differ among acromegaly subgroups (with and without CTH) and control group-1. Headache and vision problems were more frequent in CTH acromegaly patients (p < 0.05); two acromegaly patients presented with imaging and neurological signs of syringomyelia. Despite no signs of posterior fossa underdevelopment or cranial constriction, CTH is more frequent in acromegaly patients and seems to contribute to some disabling neurological symptoms.

show abstract

Resolution of Chiari malformation after treatment of acromegaly

Cited by 11 publications

References 4 publications

Craniometric changes in patients with acromegaly from a surgical perspective

Craniometric changes in patients with acromegaly from a surgical perspective

Symptomatic Chiari type 1 malformation associated with acromegaly: A case report

Herniation of cerebellar tonsils in acromegaly: prevalence, pathogenesis and clinical impact

Contact Info

Product

Resources

About