Autologous activated platelet-rich plasma gel as a sole adjunct in endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea: a case series

Abstract

Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication between the subarachnoid space and the nasal cavity, predisposing patients to potentially life-threatening meningitis if not promptly treated. Endoscopic endonasal repair has become the standard of care, with surgical success depending on precise localisation of the defect, secure multilayer closure, and the use of effective adjuncts. Platelet-rich plasma (PRP), when activated with calcium chloride to form a gel, provides a concentrated source of growth factors that enhance healing, promote rapid mucosal regeneration, and create an immediate watertight seal, offering an autologous, economical alternative to commercial fibrin sealants. This retrospective case series from a tertiary care centre in Pondicherry included five female patients aged 43-50 years who presented with spontaneous CSF rhinorrhea without any preceding trauma, surgery, or obvious precipitating factors. CT cisternography and MRI were used to localise defects, and two patients demonstrated features suggestive of idiopathic intracranial hypertension. All patients underwent endoscopic multilayer repair using fat and fascia lata grafts, with PRP gel-prepared by activating autologous PRP with calcium chloride-applied between graft layers and externally over the reconstruction site. Postoperative management included antibiotics, acetazolamide, and lumbar drainage when indicated. All five patients achieved complete resolution with no recurrence, meningitis, graft failure, or other complications during six months of follow-up. Activated PRP gel proved to be a safe, effective, and cost-efficient adjunct for reinforcing endoscopic anterior skull base CSF leak repair, although larger studies are required to validate long-term outcomes.