Background and objective Despite 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.

Method PubMed, 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.

Results Eleven 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; I² = 0.01%), and risk difference analysis (RD: 0.07, 95% CI: −0.03 to 0.17, P = 0.18; I² = 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.

Conclusion While 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.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.