Plasma-rich fibrin in neurosurgery: a feasibility study
- 152 Downloads
Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient’s own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery.
A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries.
L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair.
L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery.
KeywordsL-PRF Dural closure Skull base CSF leak Regenerative medicine
Compliance with ethical standards
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 2.Bajaj P, Pradeep AR, Agarwal E, Rao NS, Naik SB, Priyanka N, Kalra N (2013) Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial. J Periodontal Res 48:573–581. https://doi.org/10.1111/jre.12040 CrossRefPubMedGoogle Scholar
- 6.Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M (2017) Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol 44:67–82. https://doi.org/10.1111/jcpe.12643 CrossRefPubMedGoogle Scholar
- 7.Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M (2017) Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review. J Clin Periodontol 44:225–234. https://doi.org/10.1111/jcpe.12658 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Cortellini S, Castro AB, Temmerman A, Vandessel J, Pinto N, Jacobs R, Quirynen M (2018) L-PRF block for bone augmentation procedure: a proof-of-concept study. J Clin Periodontol. https://doi.org/10.1111/jcpe.12877
- 12.Dohan Ehrenfest DM, Pinto NR, Pereda A, Jimenez P, Corso MD, Kang BS, Nally M, Lanata N, Wang HL, Quirynen M (2017) The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets:1–14. https://doi.org/10.1080/09537104.2017.1293812
- 17.Grey E (1915) Fibrin as haemostasis in cerebral surgery. Surg Gynecol Obstet 21:452–454Google Scholar
- 19.Huang Y, Bornstein MM, Lambrichts I, Yu HY, Politis C, Jacobs R (2017) Platelet-rich plasma for regeneration of neural feedback pathways around dental implants: a concise review and outlook on future possibilities. Int J Oral Sci 9:1–9. https://doi.org/10.1038/ijos.2017.1 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Ito K, Yamada Y, Naiki T, Ueda M (2006) Simultaneous implant placement and bone regeneration around dental implants using tissue-engineered bone with fibrin glue, mesenchymal stem cells and platelet-rich plasma. Clin Oral Implants Res 17:579–586. https://doi.org/10.1111/j.1600-0501.2006.01246.x CrossRefPubMedGoogle Scholar
- 21.Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, Lee JY (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31:2609–2613. https://doi.org/10.1097/01.brs.0000241066.55849.41 CrossRefGoogle Scholar
- 30.Soldatova L, Campbell RG, Elkhatib AH, Schmidt TW, Pinto NR, Pinto JM, Prevedello DM, Ditzel Filho LF, Otto BA, Carrau RL (2017) Role of leukocyte-platelet-rich fibrin in endoscopic endonasal skull base surgery defect reconstruction. J Neurol Surg B Skull Base 78:59–62. https://doi.org/10.1055/s-0036-1584894 CrossRefPubMedGoogle Scholar