Clinical Efficacy of Radiation-Sterilized Allografts for Sellar Reconstruction after Transsphenoidal Surgery

Abstract

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at -70°C. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

Comparative study and histomorphometric analysis of bone allografts lyophilized and sterilized by autoclaving, gamma irradiation and ethylene oxide in rats

“…The results confirmed the findings of several authors about the possibility of clinical use of freeze-dried sterilized bone allografts 5,7,9,12,15 . Physical changes caused by these processes must be better studied to define other more adequate parameters for the choice of the sterilization method to be utilized 6 .…”

“…This encouraged the development of several studies in an effort to understand what takes place with this structure when it is transplanted and what is the best type of bone graft to be used 8,9 .…”

“…To date there is no consensus regarding the ideal sterilization to ensure preservation of the allograft potential of osteoinduction and ability for integration [5][6][7][8][9][10] . The main methods of sterilization of biological materials used today are autoclave, gamma irradiation and ethylene oxide.…”

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

“…Some authors describe a skull base craniotomy (crafting and eventually replacing a bone flap from the sellar floor) instead of traditional craniectomy, repairing the bony integrity and providing a foundation for nasoseptal flap adhesion [ 105 ]. Allograft alternatives include cadaveric radiation-sterilized iliac bone [ 106 ]. Other approaches include the use of mouldable cement (hydroxyapatite or polymethylmethacrylate) [ 29 , 70 , 79 , 89 , 107 , 108 ].…”

Reconstruction Strategy After Endoscopic Skull-Base Surgery

“…Tensor fascia lata donated from cadavers have been used in some institutions, and their effectiveness and safety are established [13]. In our experience, there was no difference between autologous grafts and allografts in terms of postoperative CSF leaks or meningitis (unpublished data).…”