title: Injectable hydroxyapatite cement patch as an on-lay graft for the sellar reconstructions following endoscopic endonasal approach.
abstract: BACKGROUND
  Skull base reconstruction after endoscopic endonasal resection of a variety of skull base lesions remains challenging because of some lethal complications such as cerebrospinal fluid (CSF) leaks. We investigated the outcomes of hydroxyapatite (HA) cement patch as on-lay graft for skull base defects following endoscopic endonasal approach (EEA).
  
  
  METHODS
  We analyzed 53 consecutive patients who underwent sellar reconstruction using HA cement following EEA at our institution between July 2009 and March 2011. Patients were composed of 23 men and 30 women with a mean age of 47 years, ranging from 10 to 72 years. Among these patients, 29 patients (54.7%) experienced intraoperative CSF leaks with high-output, 10 patients (18.9%) underwent CSF leaks with low output, and 14 patients (26.4%) experienced no intraoperative CSF leak. Mean follow-up period for clinical outcomes was 8.6 months (range, 3-22 months).
  
  
  RESULTS
  We performed injectable HA patch as on-lay graft over fascia lata for the skull base defects. Routine lumbar CSF drainage was not performed postoperatively in any patients since the introduction of HA. During the follow-up period, three of 53 patients (5.6%) demonstrated meningitis associated with postoperative CSF leaks and underwent re-do reconstruction surgery. There was no allergic symptoms associated with HA cement. At an outpatient clinic, the defects were found to be covered with surrounding nasal mucosa at an average of 14 weeks (range, 3-28 weeks).
  
  
  CONCLUSIONS
  The use of HA cement as an on-lay patch for the reconstruction of sellar defect demonstrated a low incidence of CSF leaks with minimal complications. HA cement may be an alternative option for repair of CSF leaks following EEA.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.
authors.forename: Sang-Bong
authors.initials: SB
authors.lastname: Chung
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.forename: Kwan
authors.initials: K
authors.lastname: Park
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Doo-Sik
authors.initials: DS
authors.lastname: Kong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D019737:Transplants / Q000639:trends; D055815:Young Adult
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement