複合セラミック（セラタイト）を用いた経鼻的下垂体腫瘍摘出術時のトルコ鞍底の再建術

Reconstruction of the Sellar Floor during Transnasal Pituitary Surgery Using Ceramics Composed of a Combination of Hydroxyapatite and Tricalciumphosphate

I．はじめに

　人工材料を用いた下垂体腫瘍摘出術時のトルコ鞍底の再建に関しては，これまでいくつかの報告がなされてきた^{1,2,4,5,7,13）}．近年，セラミックスの有用性が認められ，バイオセラミックスとして用いられるようになった^8）．この中でもハイドロキシアパタイト・リン酸三カルシウム複合体（hydroxyapatite and tricalciumphosphate：以下HAP・TCPと略す）は，補槇部位周囲の造骨作用を促進し，新正骨と直接結合するとされている^{3,8,9,10,14,15）}．HAP・TCP（セラタイト^®，日本特殊陶業株式会社製）は従来の骨補填材料よりも強度を有するという利点を有し，多孔体およびスペーサーは脳神経外科，整形外科，耳鼻咽喉科，形成外科，口腔外科領域において種々の骨欠損部の充填や再建に用いられている^3,9,11,16）．今回われわれは，このHAP・TCPを用いて経鼻的下垂体腫瘍摘出後のトルコ鞍底再建のためのプレート（トルコ鞍プレート）を新たに考案し，それを臨床応用したので報告する．

Our clinical experience with reconstruction of the sellar floor during transnasal-transsphenoidal surgeryfor pituitary tumors using ceramics composed of a combination of hydroxyapatite and tricalciumphosphate(pituitary plate) is described. A pituitary plate was used to reconstruct the sellar floor in 15 patients withpituitary tumors that included 13 pituitary adenomas and 2 Rathke's cleft cysts. This method is indicatedfor cases of reoperation and cases in which there is of much cerebrospinal fluid leakage during surgery.This material is provided as a pituitary plate 12 X 12 mm round and 2 mm thick. There are four holes inthe center by which the plate can be held with regular bipolar forceps. At the time of closing the sellarfloor window, a pituitary plate was carved with scissors into a suitable shape and slipped inside the bonydefect. The postoperative position of the pituitary plate could be clearly identified on skull roentgenogramand magnetic resonance imaging. No displacement or migration of the implanted pituitary plate wasobserved in any patient during follow-up radiological examinations. Infections such as a pituitary abscessor meningitis were not observed clinically or radiologically in any patient. In three patients who underwentrepeated transnasal surgery for regrowth of the tumor, the pituitary plate that had been placed at the ini-tial procedure was covered with a thin fibrous capsule and the plate was well preserved. These results indi-cate that a pituitary plate can be useful for reconstruction of the sellar floor in transnasal-transsphenoidalsurgery.