Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks

• Published in: European archives of oto-rhino-laryngology Vol. 275; no. 9; pp. 2245 - 2252
• Main Authors: Khafagy, Yasser W., Abd Elfattah, Ahmed M., Moneir, Waleed, Salem, Eman H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2018
• Subjects: Head and Neck Surgery; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Rhinology; CSF rhinorrhea; Spontaneous CSF leaks; PRF; Leucocyte–platelet-rich fibrin; Idiopathic intracranial hypertension; Endoscopic repair of CSF leak
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-018-5048-7

Background Spontaneous CSF leak is a challenging condition, with frequent recurrences following attempted surgical closure. The selection of graft materials depends on the experience of the operating surgeon. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation platelet concentrate that has currently invaded every surgical specialty. To our knowledge, no previous reports about the use of L-PRF in repair of CSF leak were published. The study was conducted to assess the potential role of L-PRF in spontaneous CSF leaks repair. Methods This prospective controlled study was conducted on 40 patients who were randomly divided into 2 groups: In group A, L-PRF was used in addition to another layer, while patients in group B underwent multilayer repair using traditional graft materials. Results Preoperative HRCT scan showed bony dehiscence ( n  = 30) and opacity in a nearby sinus ( n  = 9). MRI findings varied between empty sella in 28 patients, and meningocele in 19 patients. Mean preoperatively measured CSF pressure was 26.6 cm H 2 O. Cribriform plate was identified as the commonest site of leaks. Multiple skull defects were detected in 2 cases. Failure of repair was found in 3 patients (15%) of group B and 1 patient (5%) of group A, this difference was statistically insignificant ( P value = 0.28). Significance correlation between recurrence of CSF leak and elevated intracranial pressure was observed ( P value; 0.04). Conclusion L-PRF was found to be a good adjunct material in endoscopic spontaneous CSF leaks repair. It helps in decreasing the number of layers needed for defect closure.