Sellar Floor Reconstruction with the Medpor Implant Versus Autologous Bone After Transnasal Transsphenoidal Surgery: Outcome in 200 Consecutive Patients.
OBJECTIVE
The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant.


METHODS
The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed. Material used for sellar floor reconstruction, pathologic diagnosis, immediate inpatient complications, and long-term complications were documented and analyzed. Outpatient follow-up was documented for a minimum of 1-year duration, extending in some patients up to 5 years.


RESULTS
Of the 200 consecutive patients, 136 received sellar floor cranioplasty using the Medpor implant. Postoperative complications included 6 complaints of sinus irritation or drainage, 1 postoperative cerebrospinal fluid leak requiring operative re-exploration, 1 event of tension pneumocephalus requiring operative decompression, 1 case of aseptic meningitis, 1 subdural hematoma, and 1 case of epistaxis. The incidence of these complications did not differ from the autologous nasal bone group in a statistically significant manner.


CONCLUSIONS
Sellar floor reconstruction remains an important part of transsphenoidal surgery to prevent postoperative complications. Various autologous and synthetic options are available to reconstruct the sellar floor, and the Medpor implant is a safe and effective option. The complication rate after surgery is equivalent to or less frequent than other methods of reconstruction and the implant is readily incorporated into host tissue after implantation, minimizing infectious risk.
Department of Neurosurgery and the Kenneth R. Peak Brain and Pituitary Treatment Center, Houston Methodist Neurological Institute, Houston, Texas, USA.
Brandon D
BD
Liebelt
Department of Neurosurgery and the Kenneth R. Peak Brain and Pituitary Treatment Center, Houston Methodist Neurological Institute, Houston, Texas, USA.
Meng
M
Huang
Department of Neurosurgery and the Kenneth R. Peak Brain and Pituitary Treatment Center, Houston Methodist Neurological Institute, Houston, Texas, USA. Electronic address: Dbaskin@houstonmethodist.org.
David S
DS
Baskin
D016025:Bone Transplantation; D006801:Humans; D007016:Hypophysectomy; D008866:Microsurgery; D009296:Nasal Cavity; D057605:Natural Orifice Endoscopic Surgery; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D011095:Polyethylenes; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
C084562:Medpor; D011095:Polyethylenes
Endonasal; Endoscopic; Medpor; Pituitary adenoma; Polyethylene implant; Sellar floor reconstruction; Transsphenoidal