Cranioplasty with Adipose-Derived Stem Cells, Beta-Tricalcium Phosphate Granules and Supporting Mesh: Six-Year Clinical Follow-Up Results

Abstract

Several alternative techniques exist to reconstruct skull defects. The complication rate of the cranioplasty procedure is high and the search for optimal materials and techniques continues. To report long‐term results of patients who have received a cranioplasty using autologous adipose‐derived stem cells (ASCs) seeded on beta‐tricalcium phosphate (betaTCP) granules. Between 10/2008 and 3/2010, five cranioplasties were performed (four females, one male; average age 62.0 years) using ASCs, betaTCP granules and titanium or resorbable meshes. The average defect size was 8.1 × 6.7 cm2. Patients were followed both clinically and radiologically. The initial results were promising, with no serious complications. Nevertheless, in the long‐term follow‐up, three of the five patients were re‐operated due to graft related problems. Two patients showed marked resorption of the graft, which led to revision surgery. One patient developed a late infection (7.3 years post‐operative) that required revision surgery and removal of the graft. One patient had a successfully ossified graft, but was re‐operated due to recurrence of the meningioma 2.2 years post‐operatively. One patient had an uneventful clinical follow‐up, and the cosmetic result is satisfactory, even though skull x‐rays show hypodensity in the borders of the graft. Albeit no serious adverse events occurred, the 6‐year follow‐up results of the five cases are unsatisfactory. The clinical results are not superior to results achieved by conventional cranial repair methods. The use of stem cells in combination with betaTCP granules and supporting meshes in cranial defect reconstruction need to be studied further before continuing with clinical trials. Stem Cells Translational Medicine 2017;6:1576–1582

Inferior In Vivo Osteogenesis and Superior Angiogeneis of Human Adipose-Derived Stem Cells Compared with Bone Marrow-Derived Stem Cells Cultured in Xeno-Free Conditions

“…Whether any of these parameters are critical factors controlling the bone forming potential of ATSC warrants further investigation and there remains a shortage of studies using human ATSC. Very recently, a rare, long‐term patient follow‐up (6 years) of cranial defect reconstruction using autologous ATSC found all five patient outcomes unsatisfactory, and that no clear evidence that this technique induced bone healing, or that ATSC or their progeny formed new bone .…”

An overview of development and status of fiber-reinforced composites as dental and medical biomaterials

“…New applications are tested due to versatile properties of FRC in terms of biomechanics, possibility to add biologically active compounds to the medical device structure and into the polymer matrix. The limitations of biodegradable implants and stem cell based tissue engineering approaches in cranial bone repair can be overcome by using glass FRC-BG implants [ 140–148 ]. New applications for FRC will be found from orthopedic and trauma surgery and spine surgery and in more specific dental fields including dental implantology.…”

In situ bone regeneration of large cranial defects using synthetic ceramic implants with a tailored composition and design

“…Although promising, these strategies are still in the developmental stage, and the regeneration of large, cranial defects in humans has thus far attracted limited attention. Unsatisfactory clinical results have been achieved with autologous adipose-derived stem cells in combination with β-tricalcium phosphate (β-TCP) granules and titanium or polymer mesh ( 12 ). Encouraging results have been obtained with the combination of bone morphogenetic protein-2 (BMP-2), collagen sponges, and polylactide plates in a small group of patients ( 13 ).…”