Integrity of dural closure after autologous platelet rich fibrin augmentation: an in vitro study

Abstract

Background Watertight closure of the dura mater is fundamental in neurosurgery. Besides the classical suturing techniques, a variety of biomaterials have been proposed as sealants. Platelet rich fibrin (PRF) is an autologous biomaterial which can readily be obtained through low-speed centrifugation of patient’s own blood. It is rich in fibrin, growth factors, leucocytes and cytokines and has shown adhesive properties while promoting the physiological wound healing process. In this study, we investigated the effect of applying PRF in reinforcing the watertight dura mater closure. Methods We created an in vitro testing device, where the watertight dura mater closure could be hydrostatically assessed. On 26 fresh harvested bovine dura maters, a standardised 20-mm incision was closed with a running suture, and the leak pressure was measured first without (primary leak pressure) and then with PRF augmentation (secondary leak pressure). The two groups of measurements have been statistically analysed with the Student’s paired t test. Results The “running suture only group” had a leak pressure of 10.5 ± 1.2 cmH2O (mean ± SD) while the “PRF-augmented group” had a leak pressure of 47.2 ± 2.6 cm H2O. This difference was statistically significant (p < 0.001; paired t test). Conclusions Autologous platelet rich fibrin augmentation reliably reinforced watertight closure of the dura mater to a > 4-fold increased leak pressure after failure of the initial standard running suture technique.

Platelet-Rich Plasma-A Safe and Cost-effective Dural Sealant in Spinal Surgeries-A Systematic Review

“…The secondary leak pressure was measured following the introduction of PRP augmentation. The PRP augmentation consistently strengthened the closure, with a four times higher leak pressure compared to standard running suture technique 21 .…”

“…Other than the uid PRP, there is a solid one as well which comprises a 3d-matrix and is manually compressed and attened to form a membrane. The membrane, once formed, can be used for up to three hours 21,24,27 .…”

Leukocyte- and platelet-rich fibrin in cranial surgery: study protocol for a prospective, parallel-group, single-blinded randomized controlled non-inferiority trial {1}

“…As CSF leakage is an important complication of cranial surgery, this study is of major importance to the field of neurosurgery. Some preliminary pilot studies reported the feasibility of L-PRF as a closure aid in neurosurgery [ 9 , 16 ]. L-PRF has been reported to enhance wound healing by providing growth factors to the surrounding tissue [ 17 , 18 ].…”

Leukocyte- and platelet-rich fibrin in endoscopic endonasal skull base reconstruction: study protocol for a multicenter prospective, parallel-group, single-blinded randomized controlled non-inferiority trial

“…As CSF leakage is an important complication of EETA, this study is of major importance to the field of neurosurgery, skull base surgery, and ENT surgery. Some preliminary pilot studies reported the feasibility of L-PRF as a closure aid in neurosurgery [ 8 – 10 , 16 ]. In order to explore further possibilities of the use of L-PRF in cranial surgery, we are currently performing a similar randomized controlled trial in which L-PRF is compared to commercially available fibrin sealants for dural closure in supra- and infratentorial surgeries [ 17 ].…”