Regenerative Medicine and Skull Base Surgery. New Tools for Reconstruction of Bone and Dura?

• Main Authors: Bücheler, Markus, Wolf, G., Bootz, F., Schick, B.
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2005-916529

Introduction: In the last decades technologies like microsurgical free tissue transplantation or sophisticated implant materials have led to remarkable progress in reconstructive skull base surgery. Advances in regenerative medicine will accomplish another transformation of this speciality, notably by using tissue-engineered grafts and autologous cells including stem cells or bioactive molecules. Material and Methods: In bone tissue engineering, the combination of osteoconductive matrices, osteoinductive proteins like bone morphogenetic proteins and osteogenic progenitor cells from the bone marrow, or osteoblasts from bone biopsies offer a variety of tools for bone reconstruction in the craniofacial area. The utility of each technique is site-dependent. Osteoconductive approaches are limited in that they merely create a favorable environment for bone formation but do not play an active role in the recruitment of cells to the defect. Delivery of inductive signals from a scaffold can incite cells to migrate into a defect and control the progession of bone formation. Rapid osteoid matrix production in the defect site is best accomplished by using osteoblasts or progenitor cells. Results: In dura tissue engineering a fibrous tissue is desired. Growth factors have been found to be favorable for recruitment of cells to the defect as well as to obtain a three-dimensional cellular graft. Fibroblasts harvested by a biopsy can be cultured in fibrin glue-coated suture nets or placed directly at the site of reconstruction via the suture application technique. Conclusions: These biologically based strategies will be combined with minimally invasive operation techniques and computer-assisted imaging technologies to provide further improvement in tissue replacement and a reduced morbidity of reconstructive procedures in skull base surgery.