Sellar and Planum Reconstruction Using Absorbable Plates with Endonasal Endoscopic Surgery

Introduction: The reconstruction of large sellar and planum sphenoidale defects can be challenging. Native bone harvesting during the approach may be too small or nonexistent. Commercially available Medpor pituitary plates are too small as well. The use of titanium mesh has been described, but carries risks due to sharp edges and added difficulty with redo surgery. We describe our experience with the use of absorbable plates that allowed customization of size and shape, plus relatively easy manipulation.

Methods: We reviewed 476 consecutive patients undergoing endoscopic endonasal surgery at UCLA Medical Center over a 48 month period. Of these, 15 underwent reconstruction using the Resorb-x absorbable plating system. Resorb-x plates (Gebrüder Martin GmbH & Co) are made with Poly-D-and L Lactic Acid (PDLLA), 50% of D-lactide and 50% of L-lactide polymers that are biodegradable and absorbed by hydrolysis in ∼25 weeks. Each plate was cut to size, ranging in length from 1.5 to 4 cm. The plates were curved by temporary warming in hot sterile water. The plates were typically wedged in epidurally as a buttress over a fat autograft, but also used in a gasket-seal closure.

Results: There no intra-operative complications associated with placement of the plate nor post-operative CSF leaks. All patients underwent follow-up sinus endoscopy at one and eight weeks, with no evidence of rejection, displacement, crusting associated with the plate, nor infection. No patient has required revision/redo surgery to date.

Conclusion: Sellar and planum reconstruction using an absorbable plate provides a thin but rigid buttress that can be customized for size and shape. The plate is optimal for large defects. In our experience it is safe, effective, and with no apparent complications noted.