Clinical analysis of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery

Abstract

Objective To investigate the clinical characteristics and treatment methods of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery. Methods The clinical data of 14 patients with delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery were analyzed retrospectively. The clinical features and treatment of this complication were analyzed. Results The incidence of delayed epistaxis after procedure was 1.1% (14/1 224) in this group. Nine patients had nasal bleeding from 7 to 15 d after procedure; 2 had nasal bleeding at ≤2 d after procedure, and 3 had nasal bleeding from 3 to 4 weeks after procedure. The mean nasal bleeding time was 10.3 d after procedure. Of the 14 patients, 9 had active and permeating bleeding in nasal cavity, 4 had nasal hematorrhea, and 1 had nasal hematorrhea with shock and suffocation. Thirteen patients were sphenopalatine artery and its branch bleeding, and 1 was Littlehampton area bleeding. Nine patients used endoscopic surgery for electric coagulation hemostasis; 3 received transnasal endoscopic lower posterior naris packing hemostasis; and 1 underwent nasal packing hemostasis. One patient had asphyxia and caused respiratory arrest because of nasal hematorrhea. He showed a persistent vegetative state after cardiopulmonary resuscitation. The patients were followed up for more than 12 months (mean 15.3 months). Thirteen patients recovered well and no recurrent epistaxis occurred, one died of multiple organ failure at one month after procedure. Conclusions Delayed epistaxis is a rare complication of endoscopic transsphenoidal surgery. Early, timely, and correct individualized diagnosis and treatment can effectively control epistaxis and the prognosis is good. Key words: Neuroendoscopy; Postoperative hemorrhage; Delayed epistaxis; Endonasal transsphenoidal approach