Abstract
Background Reconstruction of surgical defects following cranial base surgery is challenging. Others have demonstrated that leukocyte-platelet-rich fibrin (L-PRF) stimulates tissue healing and bone regeneration. However, these studies have addressed mostly maxillofacial surgical wounds. Objective The objective of this study was to assess the possible adjuvant role of L-PRF in inducing neoossification of the surgical bone defect in anterior skull base surgery. Methods We identified patients who had undergone an endoscopic endonasal surgery of the anterior skull base in which L-PRF membranes were used for the reconstruction of the bone defect and who were followed up with postoperative CT scans. CT findings were then correlated with baseline scans and with the CT scans of a patient who had undergone imaging and histologic analysis after maxillofacial surgery in which L-PRF was used and in which we demonstrated bone formation. Results Five patients fulfilled the inclusion criteria. In four patients, the CT scan demonstrated closure of the bony defect by neoosteogenesis; however, the bone appeared less dense than the surrounding normal bone. A comparison with the control patient yielded similar radiological features. Conclusion This case series suggests that L-PRF may induce bone healing and regeneration at the surgical site defect. Multi-institutional studies with a larger series of patients are required to confirm this possibility.
Highlights
The endonasal endoscopic approach for lesions of the anterior skull base has decreased the morbidity associated with open approaches while achieving similar results in terms of disease control
The use of platelet concentrates in surgery and wound management is an attractive option to enhance tissue healing. One of these products is the leucocyte and platelet-rich fibrin (L-PRF), a platelet concentrate characterized by containing a dense matrix of fibrin, platelets, and leucocytes, representing a considerable improvement over its predecessor, platelet-rich plasma (PRP) [3]
PRP products are preparations without leukocytes and with a low-density fibrin network, and all the products of this family can be used as liquid solutions or in an activated gel form, but not as a solid filling material like leukocyte-platelet-rich fibrin (L-PRF) [3]
Summary
The endonasal endoscopic approach for lesions of the anterior skull base has decreased the morbidity associated with open approaches while achieving similar results in terms of disease control. Coagulation occurs during centrifugation, leading to the International Journal of Otolaryngology separation of the blood into three parts: acellular plasma as a supernatant on the top, a fibrin clot rich in platelets and leukocytes in the middle, and red blood cells at the bottom Compression turns this fibrin clot into a membrane, which can be used to fill surgical defects and/or accelerate healing [4]. Others have demonstrated that leukocyte-platelet-rich fibrin (L-PRF) stimulates tissue healing and bone regeneration These studies have addressed mostly maxillofacial surgical wounds. We identified patients who had undergone an endoscopic endonasal surgery of the anterior skull base in which L-PRF membranes were used for the reconstruction of the bone defect and who were followed up with postoperative CT scans. Multi-institutional studies with a larger series of patients are required to confirm this possibility
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