The Role of Leukocyte- and Platelet-rich Fibrin in Optimizing Outcomes in Cranial Surgery: A Systematic Review and Meta-analysis

Introduction: Postoperative cerebrospinal fluid (CSF) leakage is a significant complication in cranial surgery. Traditional techniques, such as using tissue grafts, can be associated with complications. Leukocyte- and platelet-rich fibrin (L-PRF), an autologous platelet concentrate, has emerged as a promising alternative. This systematic review and meta-analysis aims to evaluate its efficacy and safety in reducing CSF leakage and improving patient outcomes.

Methods: A comprehensive literature search was conducted using major bibliographic databases to identify studies evaluating the outcomes of L-PRF in cranial surgery. The outcomes of interest included the incidence of postoperative CSF leakage, postoperative meningitis, and postoperative headache. Risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were pooled using the fixed-effects model. Statistical significance was set at p< 0.05.

Results: Nine studies with 837 participants (504 in the L-PRF group and 333 in the control group) were included. L-PRF demonstrated a significant reduction in postoperative CSF leakage with the use of L-PRF compared to the control group (RR: 0.37, 95% CI: 0.20, 0.67, p < 0.001). This effect was consistent across different study designs as well as at different levels of the country. While a trend towards reduced postoperative meningitis was observed, the results were not statistically significant (RR: 0.56, 95% CI: 0.20, 1.58, p = 0.27). Similarly, no significant difference was found in the incidence of postoperative headache between the L-PRF and control group (RR: 0.90, 95% CI: 0.52, 1.54, p = 0.69).

Conclusion : L-PRF significantly reduces the risk of postoperative CSF leakage following cranial surgery. While further research is needed to confirm the impact of L-PRF on other postoperative outcomes, such as meningitis and headache, the current findings suggest that L-PRF is a valuable adjunct to standard clinical practice.