J Neurol Surg B Skull Base 2016; 77 - P092
DOI: 10.1055/s-0036-1580038

Role of Leukocyte Platelet Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction

Liuba Soldatova 1, Raewyn Campbell 1, Thomas Schmidt 2, Jaime Pinto 3, Daniel M. Prevedello 1, Ahmad ElKhatib 1, Leo F. Ditzel Filho 1, Bradley A. Otto 1, Ricardo L. Carrau 1
  • 1Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
  • 2University of Concepción School of Medicine, Concepción, Chile,
  • 3University of the Andes, Santiago, Chile

Objective: Autologous platelet rich preparations and fibrin glue technologies have been used for many years to promote surgical site healing. Recent advancements in the endoscopic endonasal approach and a significant increase in the extent of the skull base defects demand more elaborate reconstruction and novel techniques to expedite healing and prevent post-operative reconstruction failures. The objective of this pilot study was to investigate the effect of leukocyte platelet rich fibrin (L-PRF) on the post-operative recovery and the rate of complications in the endoscopic endonasal skull base surgery.

Methods: Between January and May of 2015, a total of 47 patients, 22 males and 25 females with mean age of 51, underwent endoscopic endonasal approach (EEA) resection of various pituitary and suprasellar masses with L-PRF membrane application during the skull base defect reconstruction. Following IRB approval, their post-op follow up records were retrospectively reviewed to evaluate the rate of CSF leaks and post-surgical healing. The crusting scale score was used as an indicator of healing progression. The healing was assessed during routine follow up with the following scale values assigned based on sinonasal endoscopy: 0-no crusting; 1-minimal crusting debrided with suction only; 2-moderate crusting requiring forceps debridement; 3-severe crusting causing obstruction. The crusting scale values were compared between 7-day and 21-day follow up.

Results: The EEA resections included in this pilot study were performed for several sellar and suprasellar lesions, with pituitary adenoma (Hardy score I-IVE) being the most common lesion. The surgery itself varied in extent involving transsphenoidal, transplanal, transclival, transcribiform, transethmoidal or transpterygoid approaches depending on the extent of the lesion. A total of 4/47 cases (8.5%) had post-operative CSF leak requiring surgical repair. One of the cases had recurrent CSF leaks with multiple repairs indicating multifactorial etiology for reconstruction failure. The crusting score assessment revealed that 17/41 (42%) patients had crusting score improvement, while 14/41 (34%) patients had no change in the crusting score 21 days post-op as compared with 7 day post-op visit. Ten patients (10/41, 31%) had no crusting on 21-day post-op exam. Only 10/41 (24%) patients had a higher crusting score during their 21-day post-op follow up. Six patient records did not have complete crusting scale information.

Discussion: This study demonstrates the potential utility of L-PRF membranes for skull base defect reconstruction with encouraging rate of healing progression after perioperative L-PRF application to the surgical site. The CSF leak rate of 8.5% found during this study is similar to the overall CSF leak rate quoted in the literature for all reconstructive techniques. The investigators expect that with a larger sample size, the rate of post-operative CSF leak with L-PRF membrane application during reconstruction will be lower. Future studies with a larger sample size and a multivariate analysis of variables that affect post-surgical healing will be conducted to better assess the role of L-PRF in the skull base defect reconstruction.