Surgical Experience of Sellar Floor Reconstruction Using the Silicone Plates

Purpose: Recently, several modified trans-sphenoidal approachs (TSAs) have been introduced to remove sellar, suprasellar, and parasellar lesions. Also, the more frequent use of neuroendoscope and the change of classic sublabial TSA routes to the endonasal or rhinoseptoplastic routes have made it difficult to harvest suitable bone splints for sellar floor reconstructions. We review our clinical experiences of using silicone plates as a substitute for bone splint in TSAs and extended TSAs.

Methods: For 9 years, silicone plates were used in 59 patients who had 45 pituitary adenomas (including 14 apoplexies), 6 tuberculum sellae meningiomas, 3 Rathke's cleft cysts, 3 craniopharyngiomas, 1 metastatic tumor, and 1 pituitary stalk neurocysticercosis. First, an otolaryngologist performed the endonasal trans-septal procedure to the floor of the sphenoid sinus. According to the usual manner of the TSA or extended TSA, the lesions were extirpated as completely as possible. Occasionally, a piece of abdominal fat was plugged into the cavity just before plugging the silicone plate. An adequate-size silicone plate was then pricked with a three-pronged fork and snapped into the bone window. All corners of the silicone plate were inserted into the extradural or intradural space and adjusted into a final adequate position. If there was a small gap between the substitute and the sellar floor, that gap was obliterated by packing with oxidized regenerated cellulose. Fibrin glue was used as a dural sealant just after implantation of the silicone plate for sellar floor reconstruction.

Results: Eight patients have been revised because of tumor recurrence or postoperative complications, which were related to the operation: 4 remnant or recurrent tumors, 3 cerebrospinal fluid leakages, and 1 optic neuropathy. Among the total 67 cases, 50 underwent standard TSAs and 17 received extended TSAs. There was no mortality case which was directly related to the surgery. The follow-up periods were varied from 6 months to 9 years.

Conclusions: From the authors' experience, advantages of the silicone plate are that is it simple to shape for any size defect and its use makes it easy to detect the previous bone window in reoperation. We recommend the use of silicone plate for sellar floor reconstruction during endonasal or rhinoseptoplastic TSA/extended TSA and for reoperation when it is difficult to obtain a suitable autologous bone splint in selected cases.