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.
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.
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).
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.
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Conflict of interest
Vasilikos I., Beck J., Grauvogel J., Nisyrios T., Grapatsas K. and Hubbe U. certify that they have no affiliations with or involvement in any organisation 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-licencing 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.
Prof. Ghanaati is a medical consultant in Mectron Inc. that produces the PRF-Centrifugation Device used in our experiments.
All procedures involving human participants were in accordance with the ethical standards of the institutional (University of Freiburg) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
“This article does not contain any studies with human participants performed by any of the authors.”
“All applicable international, national, and institutional guidelines for the care and use of animals were followed.”
Due to the in vitro nature of our experiments, there were no violations of the ARRIVE guidelines or Declaration of Helsinki for animal studies. The acquired bovine dura preparations were by-products of the normal commercial meat processing cycle, which complies with the European regulations. The blood used for the PRF preparation was acquired from healthy volunteers. After consultation with the local ethics committee of the University of Freiburg, no formal approval of the study was required.
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This article is part of the Topical Collection on Neurosurgery general
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Vasilikos, I., Beck, J., Ghanaati, S. et al. Integrity of dural closure after autologous platelet rich fibrin augmentation: an in vitro study. Acta Neurochir (2020). https://doi.org/10.1007/s00701-020-04254-4
- Watertight Dural closure
- Dural onlays
- Autologous biomaterial