Farrell Nyssa Fox, Kingdom Todd T, Getz Anne E, Lillehei Kevin O, Youssef A Samy, Ramakrishnan Vijay R
Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
World Neurosurg. 2019 Mar;123:e781-e786. doi: 10.1016/j.wneu.2018.12.034. Epub 2018 Dec 19.
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.
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.
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.
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.
据报道，Medpor多孔聚乙烯植入物用于经蝶窦手术（TSS）后鞍区重建是安全有效的。然而，我们观察到几例与该植入物相关的迟发性慢性蝶窦炎病例。本研究的目的是描述鞍区重建后与植入物相关的蝶窦炎的表现及处理。
这是一项对2008年12月至2013年1月在一家三级医疗机构接受鼻内镜下TSS并使用Medpor进行鞍区重建的患者的回顾性研究。分析了患者的人口统计学资料、初始手术处理、鼻窦症状、术后影像学检查、鼻窦炎的处理及结果。
2008年至2013年，139例患者使用Medpor进行了鞍区重建。5例患者（3.6%）在术后8至60个月出现需要手术处理的慢性蝶窦炎。所有5例患者均以门诊患者身份就诊，表现为头痛和鼻腔引流，4例患者有慢性鼻塞，3例患者有复发性鼻窦炎。在翻修手术时，所有5例患者均发现植入物周围有黏膜炎症和水肿，5例中有4例植入物暴露或部分挤出，予以取出。
TSS后可进行鞍底重建以预防术后并发症。尽管此前已描述多孔聚乙烯植入物在此方面安全有效，但外科医生应意识到随后可能出现植入物挤出和迟发性慢性蝶窦炎的风险。
