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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.
Journal of Neurological Surgery. Part B, Skull Base
|July 6, 2026
Summary
Bioengineered materials (BEM) offer promising results for skull base reconstruction (SBR), significantly reducing complications like cerebrospinal fluid leaks and infections. This systematic review confirms BEM as a viable alternative to traditional methods.
Area of Science:
- Neurosurgery
- Biomaterials Science
- Surgical Innovation
Background:
- Skull base reconstruction (SBR) is essential in skull base surgery, with multilayered vascularized tissue grafts as the current standard.
- Despite advancements, postoperative cerebrospinal fluid leaks (PO-CSF-L) and infections remain significant challenges.
- Bioengineered materials (BEM) are emerging as potential alternatives for SBR.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of BEM in SBR.
- To compare the outcomes of SBR using BEM versus traditional methods without biomaterials.
Main Methods:
- A systematic review and proportional meta-analysis of studies on BEM for SBR were conducted.
- Databases searched include Embase, PubMed, Scopus, and Cochrane.
- Comparative analysis used odds ratios to assess treatment effects for binary outcomes.
Main Results:
- Fourteen articles involving 1,960 patients (1,570 using BEM) met inclusion criteria.
- Five types of BEM were identified: hydroxyapatite, leukocyte-platelet-rich fibrin, collagen matrix, polyglycolic acid, and porous polyethylene.
- Low rates of PO-CSF-L (0.02%), CSF diversion (0.01%), and infection (0.02%) were observed with BEM. Collagen matrix showed lower infection rates than hydroxyapatite. BEM use was associated with reduced odds of PO-CSF-L.
Conclusions:
- Bioengineered materials are viable for skull base reconstruction.
- BEM are associated with low rates of postoperative cerebrospinal fluid leaks, diversions, and infections.
- BEM represent a promising advancement in skull base surgery.
