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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The Medpor sheet as a sellar buttress after endonasal transsphenoidal surgery: technical note
Jaechan Park1, Murali Guthikonda
1Department of Neurosurgery, Kyungpook National University, Daegu, Republic of Korea.
Background:
A technique to use the Medpor (porous high-density polyethylene) sheet as an optimal implant to reconstruct the sellar floor or the sphenoid rostrum in endonasal transsphenoidal surgery is described.
Method:
After endonasal transsphenoidal surgery, a 0.4-mm thick Medpor sheet is cut with scissors to a round or elliptical piece, which is placed in the sellar epidural space to reconstruct the sellar floor and buttress the pituitary gland and the sellar packing. In cases of a complete absence of the sellar floor, the sphenoid sinus is packed with autologous fat and fibrin glue, which are buttressed at the defect of the sphenoid rostrum with the Medpor sheet.
Results:
Ten patients underwent the reconstruction using the Medpor sheet in endonasal transsphenoidal surgery, and were then evaluated clinically and radiologically with magnetic resonance images (MR) postoperatively. The Medpor sheet was easy to cut with scissors and flexible to introduce through a small nostril. It was also sufficiently stiff to buttress the packing material in the sellar cavity or the sphenoid sinus. On MRI, the low-signal intensity of the implant was so remarkable without artifact helping to understand the postoperative image around the reconstructed area. There was no infection or granulomatous tissue reaction related to the implant.
Conclusion:
The Medpor sheet can be an optimal implant to reconstruct the sellar floor or the sphenoid rostrum after endonasal transsphenoidal surgery.
