Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks

Khafagy, Yasser; El-Fattah, Ahmed Musaad Abd; Moneir, Waleed; Salem, Eman H.

doi:10.1007/s00405-018-5048-7

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…A total of 14 cohort studies 14,15,17,19,25,30,33,40,44,49–53 and 12 case series 6,38,54–63 used CTC in 285 patients. Cohort studies and case reviews yielded high sensitivities of 0.95 (0.73-1.00) and 1.00 (1.00-1.00), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 28% of patients had nontraumatic leaks compared to 4% in literature. 15,32 This could be attributed to the tendency for nontraumatic leaks to not respond to conservative management and necessitating surgery. 73 CEMRC, CTC, and HRCT for traumatic leaks and HRCT, MRC, CTC, RNC for spontaneous leaks all appear to have high diagnostic accuracy.…”

Section: Specific Etiologiesmentioning

confidence: 99%

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Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Xie

Zhou

Kachra

et al. 2021

Am J Rhinol�Allergy

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Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Specific Etiologiesmentioning

confidence: 99%

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Xie

Zhou

Kachra

et al. 2021

Am J Rhinol�Allergy

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“…9 14 15 16 18 19 Three patients were managed conservatively with temporary CSF diversion in the form of a lumbar drain. 13 14 20 Three patients developed recurrent leaks, secondary to shunt malfunction and subsequently underwent shunt revision surgery. 15 19 21 Three patients with recurrent leaks within days after initial repair were managed with repeat surgery without need for a further shunting procedure.…”

Section: Resultsmentioning

confidence: 99%

“…Recurrence rates in larger case series (> n ¼ 20) ranged from 2.9 to 22%. [8][9][10][11][12][13][14][15][16][17] Excluding five studies with insufficient data, the overall recurrence rate was 10.5% (56/535 patients). Within this group, 44 (78.6%) recurred at the same site, while the remaining 12 (21.4%) recurred at a distant site.…”

Section: Recurrence Ratesmentioning

confidence: 99%

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

Hong

Kundishora

Elsamadicy

et al. 2021

J Neurol Surg B Skull Base

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Background Spontaneous cerebrospinal fluid (CSF) leaks represent a unique clinical presentation of idiopathic intracranial hypertension (IIH), lacking classical features of IIH, including severe headaches, papilledema, and markedly elevated opening pressures. Methods Following a single-institution retrospective review of patients undergoing spontaneous CSF leak repair, we performed a literature review of spontaneous CSF leak in patients previously undiagnosed with IIH, querying PubMed. Results Our literature review yielded 26 studies, comprising 716 patients. Average age was 51 years with 80.8% female predominance, and average body mass index was 35.5. Presenting symptoms included headaches (32.5%), visual disturbances (4.2%), and a history of meningitis (15.3%). Papilledema occurred in 14.1%. An empty sella was present in 77.7%. Slit ventricles and venous sinus stenosis comprised 7.7 and 31.8%, respectively. CSF leak most commonly originated from the sphenoid sinus (41.1%), cribriform plate (25.4%), and ethmoid skull base (20.4%). Preoperative opening pressures were normal at 22.4 cm H2O and elevated postoperatively to 30.8 cm H2O. 19.1% of patients underwent shunt placement. CSF leak recurred after repair in 10.5% of patients, 78.6% involving the initial site. A total of 85.7% of these patients were managed with repeat surgical intervention, and 23.2% underwent a shunting procedure. Conclusion Spontaneous CSF leaks represent a distinct variant of IIH, distinguished by decreased prevalence of headaches, lack of visual deficits, and normal opening pressures. Delayed measurement of opening pressure after leak repair may be helpful to diagnose IIH. Permanent CSF diversion may be indicated in patients exhibiting significantly elevated opening pressures postoperatively, refractory symptoms of IIH, or recurrent CSF leak.

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“…The awareness of the burden of CPTBCI has induced research in novel treatment modalities, including the application of medical honey and the refinement of surgical techniques ( Henatsch et al, 2015 ). On the other hand, the platelet-rich plasma (PRP) has been widely used to promote wound healing in many clinical settings, recently in skull-base reconstruction ( Khafagy et al, 2018 ), nasal septal surgery, tonsillectomy ( Gökçe Kütük and Özdaş, 2019 ), and laryngectomy ( Eid et al, 2020 ) due to beneficial immune, hemostatic, and regenerative effects of platelets exerted by the release of growth factors from granules and several extra-granular molecules. Despite that, research, such as PRP in otorhinolaryngology, lacks randomized controlled clinical trials ( Pachito et al, 2019 ; Vozel et al, 2020b ).…”

Section: Introductionmentioning

confidence: 99%

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial

Vozel

Božič

Jeran

et al. 2021

Front. Bioeng. Biotechnol.

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PurposeTo determine the efficacy of autologous platelet- and extracellular vesicle-rich plasma (PVRP) to treat chronic postoperative temporal bone cavity inflammation (CPTBCI) after exhausting surgical and standard conservative therapies.Materials and MethodsPatients were randomly allocated to treatment with PVRP (PVRP group) or standard conservative methods (control group) in a setting of four once-monthly checkups and subsequent follow-up. The treatment outcome was measured with the Chronic Otitis Media Questionnaire-12 (COMQ-12), CPTBCI focus surface area, and CPTBCI symptom-free time after the fourth checkup.ResultsEleven patients from each group completed the trial; 95% of patients suffered from chronically discharging mastoid cavity (the type of CPTBCI). Within four checkups, the COMQ-12 score decreased statistically significantly in the PVRP group (p < 0.001) but not in the control group (p = 0.339). The CPTBCI foci surface area decreased statistically significantly between the first and second checkups (p < 0.0005) but not between other checkups (p > 0.05) in the PVRP group. No statistically significant differences in CPTBCI foci surface area were detected between checkups in the control group (p = 0.152). Nine patients from the PVRP group and three patients from the control group were CPTBCI symptom-free at the fourth checkup. The median symptom-free time was 9.2 months (95% CI [7.4, 11.9]) in the PVRP group. Cumulatively, 49% of patients in the PVRP group remained CPTBCI symptom-free for 12.7 months after the fourth checkup.ConclusionAutologous PVRP represents a novel additional and successful treatment modality for a chronically discharging radical mastoid cavity when the surgical and standard conservative treatment methods have been exhausted.Trial Numberhttps://clinicaltrials.gov (NCT04281901).

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Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks

Abstract: 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.

Cited by 14 publications

References 20 publications

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial

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