Development of Chronic Sphenoid Sinusitis After Sellar Reconstruction with Medpor Porous Polyethylene Implant.
OBJECTIVE
The Medpor porous polyethylene implant is reported to be safe and effective for sellar reconstruction after transsphenoidal surgery (TSS). However, we have observed several cases of delayed chronic sphenoid sinusitis related to the implant. The purpose of this study is to describe the presentation and management of implant-related sphenoid sinusitis after sellar reconstruction.


METHODS
This is a retrospective study of patients who underwent endonasal TSS with Medpor sellar reconstruction between December 2008 and January 2013 at a tertiary care institution. Patient demographics, initial surgical management, sinonasal symptoms, postoperative imaging, sinusitis management, and resulting outcomes were analyzed.


RESULTS
From 2008-2013, 139 patients underwent sellar reconstruction using Medpor. Five patients (3.6%) presented between 8 and 60 months after surgery with chronic sphenoid sinusitis that required surgical management. All 5 patients presented as outpatients for management of headaches and nasal drainage, 4 patients experienced chronic nasal congestion, and 3 patients noted recurrent sinusitis. At the time of revision surgery, all 5 patients were found to have mucosal inflammation and edema surrounding the implant, and 4 of the 5 had an exposed or partially extruded implant that was removed.


CONCLUSIONS
Reconstruction of the sellar floor may be performed after TSS to prevent postoperative complications. Although porous polyethylene implants have previously been described as safe and effective for this purpose, surgeons should be aware of the risk of subsequent implant extrusion and chronic sphenoid sinusitis that can occur in a delayed manner.
['Farrell|Nyssa Fox|NF|', 'Kingdom|Todd T|TT|', 'Getz|Anne E|AE|', 'Lillehei|Kevin O|KO|', 'Youssef|A Samy|AS|', 'Ramakrishnan|Vijay R|VR|']
D000236:Adenoma D000328:Adult D000368:Aged D000369:Aged, 80 and over D001672:Biocompatible Materials D002908:Chronic Disease D004724:Endoscopy D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010911:Pituitary Neoplasms D011095:Polyethylenes D011183:Postoperative Complications D019736:Prostheses and Implants D012189:Retrospective Studies D012658:Sella Turcica D015524:Sphenoid Sinusitis D062606:Tertiary Care Centers D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D055815:Young Adult
Sphenoid sinusitis Sellar reconstruction Medpor Porous polyethylene Transsphenoidal surgery CSF leak Pituitary adenoma