The Effect of Leukocyte and Platelet-rich Fibrin Use in Skull Base Reconstruction: A Meta-analysis

Sunday, October 18, 2026

8:18 AM - 8:24 AM PT

Location: Theatre 411

Presenting Author(s)

TC

Thamiris D.D Cabral, MD

Research Fellow
Department of Otolaryngology, University of Minnesota, MN, USA
Rio De Janeiro, Rio de Janeiro, Brazil

Co-Author(s)

Enes Agah Kodalak, MD

MD
Department of Plastic, Reconstructive and Aesthetic Surgery, Medicalpark Karadeniz Hospital, Trabzon, Türkiye
Trabzon, Trabzon, Turkey
LD

Lucas Delgado, MS

MS
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, United States
GF

Guilherme Franceschini Machado, MD

MD
Santa Marcelina Hospital, Itaquera, São Paulo, Brazi, United States

Senior Author(s)

KR

Kolin Rubel, MD

MD
Department of Otolaryngology, University of Minnesota, MN, USA, United States

Disclosure(s):

Thamiris D.D. D.D Cabral, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Enes Agah Kodalak, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Endoscopic skull base reconstruction depends on achieving appropriate closure to reduce postoperative complications such as recurrence and infection. Commonly used materials include pedicled flaps, fat grafts, and fascia, yet CSF leaks occur in up to 30% of cases. Leukocyte- and platelet-rich fibrin (L-PRF), an autologous platelet concentrate, has been shown to promote epithelial regeneration and may provide additional benefit.

Methods: MEDLINE, Scopus, and the Cochrane Library were searched for randomized clinical trials (RCTs) and observational studies evaluating L-PRF as an adjuvant sealant in skull base surgery. Outcomes of interest included intraoperative and postoperative CSF leakage, meningitis, and leak recurrence.

Results: Nine studies involving 378 patients were included. Mean age ranged from 37.2-56.5 years, with follow-up from 21 days to 2 years. L-PRF showed a significant difference from controls in postoperative CSF leak (RR 0.35, 95% CI 0.12-0.98, I2=0%). However, the same was not observed for meningitis (RR 1.17, 95% CI 0.19-7.31, I2=0%). Pooled proportion of intraoperative and postoperative CSF leak rates were low (0.14, 95% CI 0.01-0.74, I2=94%, and 0.06, 95% CI 0.03-0.10, I2=0%, respectively). Meningitis and leak recurrence were also infrequent (0.03, 95% CI 0.01-0.06, I2=0%, and 0.04, 95% CI 0.01-0.08, I2=0%, respectively). Furthermore, similar findings were noted between spontaneous and iatrogenic CSF leaks (0.03, 95% CI 0.01-0.07, I2=0%, and 0.03, 95% CI 0.01-0.10, I2=0%).

Conclusions: The adjuvant use of L-PRF demonstrated a significant reduction in postoperative CSF leak compared with control groups. No statistically significant differences were observed for other outcomes, although these findings may be limited by small sample sizes. L-PRF use was associated with low complication rates in intraoperative and postoperative leak, meningitis, and recurrence. Further large-scale trials are needed to confirm its efficacy and long-term impacts.