Autologous Platelet Rich Fibrin Augmentation of the Sellar Floor to Prevent Cerebrospinal Fluid Leak After Endoscopic Endonasal Transphenoidal Approaches: Technical Note and Initial Experience

Introduction: Cerebrospinal fluid (CSF) leak is a complication after endoscopic endonasal transphenoidal resection of pituitary pathologies. Despite perioperative placement of lumbar drains to reduce intracranial pressure and reconstruction of sellar with nasoseptal flaps or commercial dura sealants, the incidence of CSF leak remains high (10%). Its management often requires revision surgery and is associated with an increased risk of infections.

Platelet rich fibrin (PRF) is an autologous low-cost biomaterial prepared form the patient’s blood after a single cycle of an 8 min angulated centrifugation. It is composed of a fibrin matrix encapsulating patients growth factors and leukocytes and is currently applied in orthopedic, maxilla-facial plastic and neurological surgery for its regenerative properties.

In this study we asses an alternative multilayer augmentation option for the sellar closure utilizing platelet-rich fibrin in two forms: a) solid membranous (s-PRF) and high-viscosity injectable (i-PRF).

Methods: We report a retrospective series of 6 patients with pituitary macroadenomas. An endoscopic transnasal transphenoidal approach was chosen for all patients.
After resection of the pathology, sellar closure was performed with membranous s-PRF obtained from centrifugation of 40 ml of patients’ blood. In a second step, 20ml of injectable i-PRF was applied as a second sealing layer. None of the patients received a lumbar drain after surgery.

Results: During a follow up period of 6 months, none of the patients reported cerebrospinal fluid leak. None of the patients developed postoperative infections or other complication related to the PRF application.

Conclusion : Sellar closure after endoscopic trans nasal transsphenoidal resection of pituitary adenomas with PRF is feasible and safe. Multilayer closure PRF augmentation is a novel technique to prevent CSF-leakage.