• I Vasilikos, J Beck, S Ghanaati, J Grauvogel, T Nisyrios, K Grapatsas, and U Hubbe.
• Department of Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Neurozentrum, Breisacher Str. 64, D-79106, Freiburg, Germany. ioannisvasilikos@icloud.com.
• Acta Neurochir (Wien). 2020 Apr 1; 162 (4): 737-743.

BackgroundWatertight closure of the dura mater is fundamental in neurosurgery. Besides the classical suturing techniques, a variety of biomaterials have been proposed as sealants. Platelet rich fibrin (PRF) is an autologous biomaterial which can readily be obtained through low-speed centrifugation of patient's own blood. It is rich in fibrin, growth factors, leucocytes and cytokines and has shown adhesive properties while promoting the physiological wound healing process. In this study, we investigated the effect of applying PRF in reinforcing the watertight dura mater closure.MethodsWe created an in vitro testing device, where the watertight dura mater closure could be hydrostatically assessed. On 26 fresh harvested bovine dura maters, a standardised 20-mm incision was closed with a running suture, and the leak pressure was measured first without (primary leak pressure) and then with PRF augmentation (secondary leak pressure). The two groups of measurements have been statistically analysed with the Student's paired t test.ResultsThe "running suture only group" had a leak pressure of 10.5 ± 1.2 cmH2O (mean ± SD) while the "PRF-augmented group" had a leak pressure of 47.2 ± 2.6 cm H2O. This difference was statistically significant (p < 0.001; paired t test).ConclusionsAutologous platelet rich fibrin augmentation reliably reinforced watertight closure of the dura mater to a > 4-fold increased leak pressure after failure of the initial standard running suture technique.

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