Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery

Constanzo, Felipe; Pinto, Jaime; Ledermann, Cristian; Schmidt, Thomas

doi:10.1227/neu.0000000000002270

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…L-PRF was also reported to reduce postoperative CSF leak by 76% in cases with intraoperative CSF leak (relative risk 0.24, 95% CI 0.06-0.87) and by 73% of patients with high-ow leak (relative risk 0.27, 95% CI 0.07-0.99). In patients undergoing surgery for diagnoses other than adenomas, in 13.4% of patients who had standard reconstruction reported postoperative leak, whereas there was no report in the PRP group (p = 0.047) 20 . Rasmussen et al reported the feasibility and protocol of using L-PRP in the reconstruction of endoscopic approaches to the sellar region 36 .…”

Section: Prp For Anterior Skull Base Reconstructionmentioning

confidence: 92%

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

Aziz,

Yaqoob,

Tariq

et al. 2024

Preprint

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Introduction Incidental durotomy (ID) is a common complication of otherwise rewarding lumbar decompression surgeries. An effective water-tight closure of the dura can potentially avoid cerebrospinal fluid (CSF) leakage and its dreaded sequel. Several sealants, grafts, and patches are used; however, the cost constrains its utility in resource-limited settings. Platelet-rich plasma (PRP) has been found effective in wound healing and adhesive properties and hence a potential adjunct for watertight closure of dura. This systematic review was conducted to highlight the existing literature on the utility of PRP in spinal procedures for the managing of CSF leaks. Methods The review was conducted based on the PRISMA guidelines. After a comprehensive database search through three databases (PubMed, Scopus, and Cochrane Library), studies assessing the role of PRP in CSF leaks or for the water-tight closure of dura were included. The study descriptions, demographic details, methodology, and outcomes were assessed. Results A total of six studies were included. In vitro studies and animal trials demonstrated the efficacy of PRP in achieving watertight dural closure and prevention of CSF leaks when standard suturing techniques failed. PRP application in rat models have been shown to cause increased dura mater thickness and enhanced vascularity. Clinical cases revealed mixed outcomes, with some patients experiencing symptom relief and improved radiological findings after PRP interventions, while a minority faced recurrent symptoms. Conclusion PRP is a promising tool to achieve water-tight dural closure. Although the clinical evidence is limited at this juncture, its feasibility, cost-effectiveness, and safety profile make it suitable for initiating clinical trials to assess its optimal clinical application.

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Section: Prp For Anterior Skull Base Reconstructionmentioning

confidence: 92%

“…Due to the wound healing and adhesive properties, it has been used as a scaffolding layer for dural repair. Although it has not been widely used, initial studies are promising 19,20 . As prepared from the receiver's blood, its application has nearly no reported complications or adverse effects 16,17 .…”

Section: Introductionmentioning

confidence: 99%

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

Aziz,

Yaqoob,

Tariq

et al. 2024

Preprint

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“…Similarly, in a recent RCT study by Constanzo et al, 103 patients who underwent an endoscopic endonasal approach and were reconstructed using a standard technique were compared with 139 patients using the same protocol with the addition of L-PRF, postoperative intracranial infection and CSF leak at 6 months. The researchers found that PRF reduced the rate of postoperative CSF leaks in patients with intraoperative leaks, without differences on postoperative meningitis [ 244 ].…”

Section: Use Of Plasma Rich With Platelets and Extracellular Vesicles...mentioning

confidence: 99%

Autologous Platelet and Extracellular Vesicle-Rich Plasma as Therapeutic Fluid: A Review

Troha

Vozel

Arko

et al. 2023

IJMS

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The preparation of autologous platelet and extracellular vesicle-rich plasma (PVRP) has been explored in many medical fields with the aim to benefit from its healing potential. In parallel, efforts are being invested to understand the function and dynamics of PVRP that is complex in its composition and interactions. Some clinical evidence reveals beneficial effects of PVRP, while some report that there were no effects. To optimize the preparation methods, functions and mechanisms of PVRP, its constituents should be better understood. With the intention to promote further studies of autologous therapeutic PVRP, we performed a review on some topics regarding PVRP composition, harvesting, assessment and preservation, and also on clinical experience following PVRP application in humans and animals. Besides the acknowledged actions of platelets, leukocytes and different molecules, we focus on extracellular vesicles that were found abundant in PVRP.

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Platelet rich fibrin three-layer reconstruction of the sellar floor after endoscopic endonasal transsphenoidal approach: technical note and initial experience

Shah,

Argiti,

Nakagawa

et al. 2024

Front. Surg.

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BackgroundCerebrospinal fluid (CSF) leakage frequently complicates endoscopic endonasal transsphenoidal pituitary resections, despite the use of lumbar drains, nasoseptal flaps, or commercial dura sealants. Managing this complication often requires revision surgery and increases the risk of infection. Platelet-rich fibrin (PRF), an affordable autologous biomaterial derived from the patient's blood through short, angulated centrifugation, contains growth factors and leukocytes embedded in a fibrin matrix. PRF exhibits regenerative properties in various surgical disciplines. This study assesses a three-layer sellar reconstruction method employing solid membranous (s-PRF) and high-viscosity injectable (i-PRF) forms of PRF.Materials and methodsWe present our initial experience on a series of 22 patients with pituitary macroadenomas. For all patients, an endoscopic transnasal transsphenoidal approach was selected. Following the resection of the pathology, sellar reconstruction was accomplished using a three-layer orthobiologic technique. A membranous s-PRF was utilized as an inlay inside the opened sellar floor, followed by a layer of injectable i-PRF finally covered with another s-PRF membrane over the top to the sellar corridor.ResultsIn all cases the implementation of the proposed three-layer PRF reconstruction strategy was feasible and safe. During the 12-month follow-up period there were no adverse effects reported associated with the PRF application. 77% (17/22) of the patients demonstrated intraoperatively a cerebrospinal fluid (CSF) leak (Esposito Grade 1–3). In total, the proposed PRF reconstruction effectively prevented postoperative CSF leaks in 95% of the patients and in 94% of those with an Esposito Grade 1–3. One of the two patients with intraoperative Esposito Grade 3 developed a CSF leak on the first postoperative day, which was successfully managed with a lumbar drain for 5 days.ConclusionSellar reconstruction after endoscopic endonasal transsphenoidal resection of pituitary adenomas with PRF is feasible and safe. The three layer PRF augmentation is a novel technique to prevent CSF-leakage.

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Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery

Cited by 3 publications

References 38 publications

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

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

Autologous Platelet and Extracellular Vesicle-Rich Plasma as Therapeutic Fluid: A Review

Platelet rich fibrin three-layer reconstruction of the sellar floor after endoscopic endonasal transsphenoidal approach: technical note and initial experience

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