Deployment of a bioabsorbable plate as the rigid buttress for skull base repair after endoscopic pituitary surgery

Qichao Qi; Yongpeng Zhang; Junpeng Wang; Hanlin Zhong; Haijun Chen; Chuanwei Wang; Jiangang Wang; Xiaolan Cai; Lei Sun; Shilei Ni

doi:10.21037/gs-20-642

Deployment of a bioabsorbable plate as the rigid buttress for skull base repair after endoscopic pituitary surgery

Gland Surg. 2021 Mar;10(3):1010-1017. doi: 10.21037/gs-20-642.

Authors

Qichao Qi^{1

2

3}, Yongpeng Zhang^{1

4}, Junpeng Wang¹, Hanlin Zhong¹, Haijun Chen¹, Chuanwei Wang¹, Jiangang Wang¹, Xiaolan Cai⁵, Lei Sun⁶, Shilei Ni^{1

2

3}

Affiliations

¹ Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China.
² Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China.
³ Shandong Key Laboratory of Brain Function Remodeling, Jinan, China.
⁴ Department of Neurosurgery, Rizhao Central Hospital, Rizhao, China.
⁵ Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan, China.
⁶ Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China.

Abstract

Background: Bioresorbable alloplastic implants have become desirable as a rigid buttress for reconstructing skull base defects. This study aimed to describe the use of a biodegradable plate (PolyMax RAPID) in skull base repair of endoscopic endonasal pituitary surgery and to investigate the clinical outcome and safety of this novel method.

Methods: Between January 2019 and January 2020, 22 patients with pituitary adenomas who underwent endoscopic skull base repair with a Polymax RAPID plate were included. After endonasal transsphenoidal surgery, a trimmed bioresorbable plate was placed in the position between the dura and the bone of the skull base to reconstruct the sellar floor and buttress the pituitary gland and sellar packing. The patient demographics, radiologic imaging, and postoperative outcomes were carefully reviewed. All patients were followed up by a routine nasal endoscopic assessment and radiologic examinations.

Results: The present study comprised 10 (45.5%) males and 12 (54.4%) females with an average age of 51.9 years. There were 7 (31.8%) growth hormone (GH) secreting adenomas, 2 (9.1%) thyroid stimulating hormone (TSH) secreting adenomas, and 13 (59.1%) non-functioning adenomas. Enlarged sellar floor and paranasal sinusitis were seen in 13 (59.1%) and 11 (50.0%) cases shown by preoperative computed tomography (CT) or magnetic resonance imaging (MRI), respectively. There were 6 (27.3%) grade-1 and 16 (72.7%) grade-0 cases by intraoperative cerebrospinal fluid (CSF) leak grading. None of these patients received lumbar drains postoperatively and no postoperative CSF rhinorrhea was detected in our series. The PolyMax RAPID plates which could be clearly identified on postoperative CT or sagittal T1-weighted MRI were shown to provide an ideal rigid buttress for sellar repair.

Conclusions: The Polymax RAPID plate can be an optimal implant to achieve rigid repair of sellar floor defects after endonasal transsphenoidal pituitary surgery.

Keywords: Endoscopic transsphenoidal surgery; bioabsorbable material; pituitary adenomas; skull base reconstruction.