Ramos-Zúñiga Rodrigo, López-González Francisco, Segura-Durán Ivan
Translational Neurosciences Institute, Department of Neurosciences, University Center of Health Sciences CUCS, Universidad de Guadalajara, Guadalajara, Mexico.
Department of Neurosurgery, Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Mexico.
Front Bioeng Biotechnol. 2020 Feb 25;8:122. doi: 10.3389/fbioe.2020.00122. eCollection 2020.
Endoscopic endonasal transsphenoidal surgery (EETS) is a standard technique used to approach sellar tumors. It is relatively safe, minimally invasive and carries a low risk of complications. However, one of the common complications reported with this technique is CSF leakage which causes morbidity, an increase in recovery time and hospital costs. This complication usually occurs from violation of the diaphragma sellae and a defect in the structures of the sellar floor or incomplete repair. In this article we report the first case with the use of a novel bilaminar chitosan scaffold which can be potentially used in the repair of the sellar floor, primarily aiming to the bony part of this structure.
After a personalized design employing a tissue engineering strategy, we reconstructed the sellar floor in a 65-year-old woman who had undergone EETS for a pituitary adenoma with progressive bilateral visual loss. To repair the bony defect of the sellar floor, we used a novel bilaminar chitosan scaffold. The patient had an unremarkable postoperative course with no evidence of CSF leak. The polymer was well tolerated without toxicity, infection or complications. After 2 years of follow up the patient remains neurologically intact, and in good endocrinological status.
This is the first report of the use of this biomaterial and its biocompatibility in a clinical setting for the repair of the sellar floor during EETS. Our experience with chitosan bilaminar scaffold and in several preclinical studies in the literature have demonstrated good biocompatibility and effective bioengineered bone regeneration due to its excellent osteoconductive properties, this study pretends to be one landmark for further clinical research and larger case series with the use of this personalized tissue engineering materials in order to see they real efficacy to increase the surgeon armamentarium.
鼻内镜下经蝶窦手术（EETS）是治疗鞍区肿瘤的标准技术。该技术相对安全、微创，并发症风险低。然而，该技术常见的并发症之一是脑脊液漏，这会导致发病、恢复时间延长和住院费用增加。这种并发症通常是由于蝶鞍隔膜受损、鞍底结构缺陷或修复不完全所致。在本文中，我们报告了首例使用新型双层壳聚糖支架的病例，该支架可能用于鞍底修复，主要针对该结构的骨质部分。
我们采用组织工程策略进行个性化设计后，为一名65岁女性重建了鞍底。该女性因垂体腺瘤接受了EETS手术，出现进行性双侧视力丧失。为修复鞍底骨缺损，我们使用了新型双层壳聚糖支架。患者术后病程顺利，无脑脊液漏迹象。该聚合物耐受性良好，无毒性、感染或并发症。经过2年随访，患者神经功能完好，内分泌状态良好。
这是首次报道在临床环境中使用这种生物材料及其生物相容性来修复EETS期间的鞍底。我们对壳聚糖双层支架的经验以及文献中的多项临床前研究表明，由于其优异的骨传导特性，该支架具有良好的生物相容性和有效的生物工程骨再生能力。本研究旨在成为进一步临床研究和更大病例系列的一个里程碑，以便观察使用这种个性化组织工程材料的实际疗效，从而增加外科医生的治疗手段。
