Non-traumatic superior hypophyseal aneurysm with associated pseudoaneurysm presenting with massive epistaxis

Abstract

Although a common medical problem, epistaxis rarely requires eurosurgical intervention. Bleeding most commonly occurs from iesselbach’s plexus in the anterior septal area and usually resolves ith manual compression, vasoconstrictors, or simple nasal packng. Epistaxis from the posterior nasal cavity is more difficult to anage and if not resolved with conservative measures, sometimes equires endoscopic cauterization or endovascular embolization of he internal maxillary artery (IMA). Rare neurosurgical causes of pistaxis include traumatic and infectious pseudoaneurysms, cavrnous aneurysms, sellar tumors, and dural arteriovenous fistulas. The first case of massive epistaxis caused by an intracranial neurysm was published at a lecture at the Royal College of Sureons of England by Dr. Beadles in 1907 [1]. Since then, there ave been several reports of severe epistaxis from aneurysms r pseudoaneurysms eroding into the paranasal sinuses [2]. The ajority of these reports are extradural pseudoaneurysms of the C4 egment secondary to severe head trauma, particularly with fracures of the skull base [2]. Although extremely rare, non-traumatic neurysms or pseudoaneurysms causing massive epistaxis have lso been reported in the literature. Again, these are generally xtradural aneurysms most commonly of the C4 segment. Known auses include radiation, infection, and aneurysms associated with umors.