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Plasma-rich fibrin in neurosurgery: a feasibility study

Acta Neurochirurgica volume 160, pages 1497–1503 (2018)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Author information

Affiliations

  1. Department of Neurosurgery, University Hospitals Leuven, 3000, Leuven, Belgium

    Tom Theys, Anais Van Hoylandt, Charlotte-Elise Broeckx & Johannes van Loon

  2. Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium

    Laura Van Gerven

  3. Department of Maxillofacial surgery, University Hospitals Leuven, Leuven, Belgium

    Joyce Jonkergouw

  4. Department of Periodontology & Oral Microbiology, University Hospitals Leuven, Leuven, Belgium

    Marc Quirynen

Authors
  1. Tom Theys
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  2. Anais Van Hoylandt
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  3. Charlotte-Elise Broeckx
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  4. Laura Van Gerven
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  5. Joyce Jonkergouw
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  7. Johannes van Loon
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Correspondence to Tom Theys.

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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.

Ethical approval

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.

Informed consent

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.

Additional information

This article is part of the Topical Collection on Neurosurgery general

Tom Theys is a Senior Clinical Investigator of FWO Flanders (FWO 1830717N).

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Theys, T., Van Hoylandt, A., Broeckx, CE. et al. Plasma-rich fibrin in neurosurgery: a feasibility study. Acta Neurochir 160, 1497–1503 (2018). https://doi.org/10.1007/s00701-018-3579-8

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  • DOI: https://doi.org/10.1007/s00701-018-3579-8

Keywords

  • L-PRF
  • Dural closure
  • Skull base
  • CSF leak
  • Regenerative medicine