Efficacy of platelet-rich products in preventing cerebrospinal fluid leakage following neurosurgical procedures: A systematic review and meta-analysis

Background and objectiveDespite advancements in dural closure techniques and materials, cerebrospinal fluid (CSF) leakage remains a major issue for neurosurgeons. This systematic review assesses the efficacy of platelet-rich products in reducing post-operative CSF leakage. MethodPubMed, Scopus, Web of Science, EMBASE, Clinicaltrials.gov, and Google Scholar were searched using the following keywords: "platelet-rich products", "cerebrospinal fluid leak", "cranial surgery", and "spinal surgery". Original studies using platelet-rich products to reduce CSF leaks were included. Meta-analysis used a random-effects model to calculate risk ratios and risk differences. The GRADE tool was used to assess the certainty of evidence. Statistical analyses were performed in STATA 17 and R. ResultsEleven studies were included in the qualitative synthesis and five in the quantitative meta-analysis. Leukocyte-rich platelet fibrin (L-PRF) was the most commonly used product (k = 9). Most studies involved endoscopic endonasal skull base surgeries (K = 9). Meta-analysis demonstrated a non-significant effect in CSF leak prevention by relative risk analysis (RR: 1.03, 95% CI: 1.00-1.06, P = 0.06; I{superscript 2} = 0.01%), and risk difference analysis (RD: 0.07, 95% CI: -0.03 to 0.17, P = 0.18; I{superscript 2} = 72.57%). Qualitative analysis showed lower rates of meningitis and improved wound healing in intervention groups, with no serious adverse events attributed to platelet-rich products. ConclusionWhile platelet-rich products showed promise in preventing CSF leaks and reducing postoperative complications, their effectiveness was not statistically significant. Well-designed randomized controlled trials with larger populations are needed to establish their role in neurosurgical procedures.