Nishioka H, Ohno S, Ikeda Y, Ohashi T, Haraoka J
Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan.
Acta Neurochir (Wien). 2007;149(5):523-6; discussion 526-7. doi: 10.1007/s00701-007-1134-0. Epub 2007 Apr 4.
To describe delayed massive epistaxis, a rare but serious complication after transsphenoidal surgery.
Two patients underwent microscopic transsphenoidal surgery through a right endonasal approach for nonfunctioning pituitary adenoma. Severe epistaxis suddenly developed on day 8 and on day 13, respectively, after uneventful surgery. In each patient, the epistaxis was due to arterial haemorrhage from the left posterior nasal cavity. Otolarygologists failed to detect the origin of bleeding which was refractory to conservative treatment. Emergency internal carotid or external carotid angiography, performed during tight packing of the posterior nasal cavity, did not show abnormal findings; nevertheless, each patient was treated successfully by endovascular embolisation of the external carotid artery without further complication.
When severe delayed epistaxis follows transsphenoidal surgery and damage to the internal carotid artery has been ruled out, endovascular embolisation of the external carotid artery should be considered in patients refractory to conservative treatment.
描述延迟性大量鼻出血，这是经蝶窦手术后一种罕见但严重的并发症。
两名患者因无功能性垂体腺瘤经右侧鼻内入路接受了显微镜下经蝶窦手术。在手术顺利进行后的第8天和第13天，分别突然发生严重鼻出血。每名患者的鼻出血均源于左后鼻腔的动脉出血。耳鼻喉科医生未能检测到出血源，保守治疗无效。在后鼻腔紧密填塞期间进行的急诊颈内动脉或颈外动脉血管造影未显示异常结果；尽管如此，每名患者均通过颈外动脉血管内栓塞成功治疗，未出现进一步并发症。
经蝶窦手术后发生严重延迟性鼻出血且已排除颈内动脉损伤时，对于保守治疗无效的患者应考虑行颈外动脉血管内栓塞。
