Bioengineered Materials for Skull Base Reconstruction – Current Clinical Applications: Systematic Review and Meta-analysis

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 1075 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 1960 patients, with 1570 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 to 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.