Application of Fibrin Rich in Leukocytes and Platelets in the Reconstruction of Endoscopic Approaches to the Skull Base

• Published in: World neurosurgery 2018-10, Vol.118, p.32-41
• Main Authors: Rasmussen, Jorge, Ruggeri, Carlos, Ciraolo, Carlos, Baccanelli, Matteo, Yampolsky, Claudio, Ajler, Pablo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Platelets; Cerebrospinal fluid leak; Female; Fibrin Tissue Adhesive - administration & dosage; Humans; L-PRF; Leukocytes; Male; Middle Aged; Neuroendoscopy - methods; Reconstructive Surgical Procedures - methods; Regenerative medicine; Skull base; Skull Base - diagnostic imaging; Skull Base - surgery; Transsphenoidal endoscopic approach
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.180

The objective of this work is to report the feasibility and results of an institutional protocol for the application of an innovative biologically active hemoderivative autologous material, denominated leukocyte- and platelet-rich fibrin (L-PRF), in the reconstruction of endoscopic approaches to the sellar region. L-PRF membranes were produced from centrifuged autologous venous blood. They were used for the reconstruction of transsphenoidal endoscopic approaches to the sellar region in 12 patients. The trophism of the mucosa was monitored during the first 30 days by means of fiberoptic endoscopic controls on the second and seventh postoperative days. Follow-up was performed to rule out complications up to 30 postoperatively days. The product obtained bore the characteristics of the original descriptions of L-PRF. Standardized preparation of L-PRF membranes promoted early regeneration of the sphenoid sinus mucosa to close endoscopic approaches to the sellar region. No complications within the first 30 postsurgical days were reported. L-PRF membranes offer characteristics that are superior to other techniques and products, mainly because of their role as biological promoters of tissue regeneration, their low economic cost, and immediate availability. However, it would be necessary to confirm these results in studies involving more patients. •L-PRF is an autologous membrane, biologically active, easy to produce and to instrument.•L-PRF was obtained by a simple, brief peripheral blood centrifugation cycle.•Can be used alone or as an adjuvant to other closure techniques.•Restitution of 90% of the removed mucosa layer at 48 hours after surgery was seen by fiberoscopy, without complications.•L-PRF membranes provide an inexpensive, widely available, and quickly affordable option for skull base reconstruction.