Development of Chronic Sphenoid Sinusitis After Sellar Reconstruction with Medpor Porous Polyethylene Implant

Abstract

■ 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.

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

“…bone) or synthetic (e.g. Medpor, titanium mesh) [ 92 , 109 , 131 , 137 – 140 ]. Medpor buttresses were commonly used, having the advantage of being mouldable, porous and relatively inert [ 57 , 92 , 137 , 139 ].…”

“…Medpor, titanium mesh) [ 92 , 109 , 131 , 137 – 140 ]. Medpor buttresses were commonly used, having the advantage of being mouldable, porous and relatively inert [ 57 , 92 , 137 , 139 ]. Titanium mesh, although strong and mouldable, is not porous.…”

Delayed Infection of Porous Polyethylene Implants After Oncologic Maxillectomy and Reconstruction: 2 Case Reports and Review of Literature

“…All 5 of the patients were found to have mucosal inflammation and edema surrounding the implant and 4 of the 5 presented with partially extruded implants. 10 Another study by Jung et al reviewing long-term outcomes in porous polyethylene orbital implants saw a smaller rate of infection, at 1% (n ¼ 314), with all 3 cases requiring implant exchange. 11 While uncommon, late implant infections are usually secondary to bacterial seeding from another active source or exposure to the upper aerodigestive tract.…”

Isolated Fungal Sphenoid Sinusitis After Endonasal Transsphenoidal Approach

“…1 The materials remained in the sphenoid sinus for reconstruction such as buttress materials (bone chip, cartilage, or titanium mesh) and tissue sealants in the surgical field may trigger tissue reaction and obstruct sphenoidotomy outlet. 7,8 Partially obstructed sphenoid sinus with stasis of nasal discharges may provide a good condition for settlement of bacteria and/or fungi, and well-aerated sinus with sufficient nutrition support may lead fungal hyphae formation in the sinus, shown in this case.…”

“…1 The materials remained in the sphenoid sinus for reconstruction such as buttress materials (bone chip, cartilage, or titanium mesh) and tissue sealants in the surgical field may trigger tissue reaction and obstruct sphenoidotomy outlet. 7,8…”