Cranial base reconstruction after transsphenoidal surgery with bioabsorbable implants.

Abstract

Reconstruction of the cranial base is often necessary after transsphenoidal surgery to prevent the occurrence of cerebrospinal fluid rhinorrhea and to maintain anatomic integrity. In most cases, sellar packing (fat, muscle, gelatin sponge) may be supported by bone or cartilage harvested at the time of surgery. The use of synthetic material, however, becomes desirable in cases in which an autograft is not available. Low-molecular-weight polylactide implants may serve as an effective alternative because they are immunologically inert, magnetic resonance imaging-compatible, and easily contoured to custom-fit a defect. MacroSorb (MacroPore, San Diego, CA) absorbable plates are made from amorphous 70:30 poly (L-lactide-co-D,L-lactide) polymers. Implants are malleable at temperatures of 70 degrees C and solidify at room or body temperature; plates are resorbed in 18 months. Polylactide polymer implants are effective adjuncts in transsphenoidal surgery when cranial base reconstruction is necessary and when an endogenous osseous or cartilaginous graft is unavailable.