Application of Fibrin Rich in Leukocytes and Platelets in the Reconstruction of Endoscopic Approaches to the Skull Base Jorge Rasmussen 1 , Carlos Ruggeri 2 , Carlos Ciraolo 1 , Matteo Baccanelli 1 , Claudio Yampolsky 1 , Pablo Ajler 1 - BACKGROUND: The objective of this work is to report the feasibility and results of an institutional protocol for the application of an innovative biologically active hemoder- ivative autologous material, denominated leukocyte- and platelet-rich fibrin (L-PRF), in the reconstruction of endo- scopic approaches to the sellar region. - METHODS: L-PRF membranes were produced from centrifuged autologous venous blood. They were used for the reconstruction of transsphenoidal endoscopic ap- proaches to the sellar region in 12 patients. The trophism of the mucosa was monitored during the first 30 days by means of fiberoptic endoscopic controls on the second and seventh postoperative days. Follow-up was performed to rule out complications up to 30 postoperatively days. - RESULTS: The product obtained bore the characteristics of the original descriptions of L-PRF. Standardized prepa- ration of L-PRF membranes promoted early regeneration of the sphenoid sinus mucosa to close endoscopic ap- proaches to the sellar region. No complications within the first 30 postsurgical days were reported. - CONCLUSIONS: L-PRF membranes offer characteristics that are superior to other techniques and products, mainly because of their role as biological promoters of tissue regeneration, their low economic cost, and immediate availability. However, it would be necessary to confirm these results in studies involving more patients. INTRODUCTION T he transsphenoidal approach is one of the most widely used techniques in neurosurgery, 1,2 initially in microsur- gery and then for endoscopy with the aim to treat, mainly, pituitary adenomas. Its main advantage is the decreased morbidity associated with the transcranial approach through a more direct access. However, the narrowness of the surgical corridor prevents a hermetic closure of the dura mater, as conventionally performed in the transcranial approach. In this way, a relatively frequent complication occurs in transsphenoidal approaches: cerebrospinal fluid (CSF) leak, the incidence of which has increased as a result of the expanded endoscopic approaches to the skull base. 3,4 Treatment of the leak usually requires complementary proced- ures, to stop CSF loss. Once the leak is confirmed, closure of the surgical planes is delayed. This situation provides access to germs from mainly the skin and mucosal flora, favoring postoperative meningitis. Another complication caused by CSF leak is CSF hy- potension, the consequences of which may range from orthostatic headache to subdural hematomas. CSF leak increases post- operative morbidity, intrahospital length of stay, and the use of economic resources. 3-5 Scarring of the endonasal endoscopic approach implies the restitution of the incised planes, which can be identified as rhi- nosinusal mucosa, bone (commonly the sellar floor, sphenoid bone, or clivus), dura mater, and arachnoid mater. Many lesions resected by the transsphenoidal route are limited to the sellar region. Therefore, the indemnity of the suprasellar cistern is generally preserved; the risk of CSF fistula is lower in these cases, but not negligible 6,7 in view of the potential seriousness of the entity. In cases in which the arachnoid plane is incised either in a programmed or in an accidental manner, hermetic closure that Key words - Cerebrospinal fluid leak - L-PRF - Regenerative medicine - Skull base - Transsphenoidal endoscopic approach Abbreviations and Acronyms CSF: Cerebrospinal fluid L-PRF: Leukocyte- and platelet-rich fibrin PRF: Platelet-rich fibrin PRP: Platelet-rich plasma From the Departments of 1 Neurosurgery and 2 Otolaryngology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina To whom correspondence should be addressed: Jorge Rasmussen, M.D. [E-mail: jorge.rasmussen@hospitalitaliano.org.ar] Supplementary digital content available online. Citation: World Neurosurg. (2018) 118:32-41. https://doi.org/10.1016/j.wneu.2018.06.180 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. 32 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2018.06.180 Doing More with Less