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Bioengineered Materials for Skull Base Reconstruction-Current Clinical Applications: Systematic Review and
Guilherme Gago1,2, Marc-Olivier Comeau3, Rodrigo Ness4
1Department of Neurosurgery, CHU de Québec - Université Laval, Québec, QC, Canada.
Introduction:
Skull base reconstruction (SBR) is a crucial aspect of open and endoscopic skull base surgery. Currently, multilayer reconstruction with vascularized tissues is the standard technique. Despite advancements, complications such as postoperative cerebrospinal fluid leaks (PO-CSF-L) and infections persist. Bioengineered materials (BEM) have emerged for SBR, showing promising results.
Methods:
A systematic review was conducted using Embase, PubMed, Scopus, and Cochrane databases. We performed a proportional meta-analysis of studies utilizing BEM for SBR and a comparative analysis with control groups that underwent SBR without biomaterials. The odds ratio assessed treatment effects for binary outcomes.
Results:
From 1,075 potential articles, 14 met the inclusion criteria. Five BEM were identified: hydroxyapatite (HXA), leukocyte-platelet-rich fibrin (L-PFR), collagen matrix (CM), polyglycolic acid (PGA), and porous polyethylene (PP). The analysis included 1,960 patients, with 1,570 in experimental groups using BEM. Pooled data indicated a PO-CSF-L proportion of 0.02% (95% CI: 0.01-0.03%), postoperative CSF diversion (PO-CSF-d) at 0.01% (95% CI: 0.00-0.04), and PO infection at 0.02% (95% CI: 0.00-0.05%). Common effect models showed that CM had a lower total PO infection rate (0.01; 95% CI: 0.00-0.01, p = 0.0006) compared with HXA (0.08; 95% CI: 0.05-0.11, p = 0.0007). Comparative analysis demonstrated lower odds of PO-CSF-L (OR 0.37; 95% CI: 0.15-0.89, p = 0.026) and infections (OR 0.47; 95% CI: 0.13-1.47, p = 0.264) in patients with BEM.
Conclusion:
Our results indicate that bioengineered materials are viable for skull base reconstruction, associated with low rates of postoperative CSF leaks, diversions, and infections.
