Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks.
BACKGROUND
Spontaneous CSF leak is a challenging condition, with frequent recurrences following attempted surgical closure. The selection of graft materials depends on the experience of the operating surgeon. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation platelet concentrate that has currently invaded every surgical specialty. To our knowledge, no previous reports about the use of L-PRF in repair of CSF leak were published. The study was conducted to assess the potential role of L-PRF in spontaneous CSF leaks repair.


METHODS
This prospective controlled study was conducted on 40 patients who were randomly divided into 2 groups: In group A, L-PRF was used in addition to another layer, while patients in group B underwent multilayer repair using traditional graft materials.


RESULTS
Preoperative HRCT scan showed bony dehiscence (n = 30) and opacity in a nearby sinus (n = 9). MRI findings varied between empty sella in 28 patients, and meningocele in 19 patients. Mean preoperatively measured CSF pressure was 26.6 cm H2O. Cribriform plate was identified as the commonest site of leaks. Multiple skull defects were detected in 2 cases. Failure of repair was found in 3 patients (15%) of group B and 1 patient (5%) of group A, this difference was statistically insignificant (P value = 0.28). Significance correlation between recurrence of CSF leak and elevated intracranial pressure was observed (P value; 0.04).


CONCLUSION
L-PRF was found to be a good adjunct material in endoscopic spontaneous CSF leaks repair. It helps in decreasing the number of layers needed for defect closure.
['Khafagy|Yasser W|YW|', 'Abd Elfattah|Ahmed M|AM|', 'Moneir|Waleed|W|', 'Salem|Eman H|EH|']
D000328:Adult D002559:Cerebrospinal Fluid Rhinorrhea D005260:Female D006801:Humans D019586:Intracranial Hypertension D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D057605:Natural Orifice Endoscopic Surgery D000073183:Platelet-Rich Fibrin D011446:Prospective Studies D012008:Recurrence D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D055815:Young Adult
Spontaneous CSF leaks CSF rhinorrhea Endoscopic repair of CSF leak Idiopathic intracranial hypertension Leucocyte–platelet-rich fibrin PRF