Incidence, risk factors and management of severe post-transsphenoidal epistaxis

Reyes, Kenneth M. De Los; Gross, Bradley A.; Frerichs, Kai U.; Dunn, Ian F.; Lin, Ning; Rincón-Torroella, Jordina; Annino, Donald J.; Laws, Edward R.

doi:10.1016/j.jocn.2014.07.004

Cited by 36 publications

(27 citation statements)

References 22 publications

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“…[1–4] Transsphenoidal resection (TSR), the preferred first-line treatment for acromegaly, has the ability to achieve biochemical and clinical remission upon complete adenoma extirpation, with modest complication rates. [5–9] Significant improvements in life expectancy have been associated with successful adenoma resection. [10]…”

Section: Introductionmentioning

confidence: 99%

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

et al. 2017

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“…It was not reported whether the PSB had been injured intraoperatively. De Los Reyes et al reviewed 551 TSAs and reported a 3.3% incidence of postoperative arterial epistaxis after TSA and a 0.5% incidence of postoperative epistaxis from the SPA or its branches . None of the aforementioned studies reported the incidence of intraoperative PSB injury, so the current study is the first to determine the incidence of postoperative epistaxis from the PSB after intraoperative injury.…”

Section: Discussionmentioning

confidence: 77%

“…Postoperative major or arterial epistaxis after ESS or endoscopic skull base surgery is uncommon, occurring in 0.6‐1.1% of ESSs and about 1‐3.3% of TSAs . Stankiewicz et al retrospectively reviewed 3402 ESSs, and demonstrated a 1.1% incidence of major postoperative epistaxis.…”

Section: Discussionmentioning

confidence: 99%

Postoperative epistaxis and sphenoid sinus ostial stenosis after posterior septal branch injury during sphenoidotomy

Kam

Ahmad

Williams

et al. 2019

Int Forum Allergy Rhinol

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Background: Postoperative arterial epistaxis and sphenoid sinus stenosis a er sphenoidotomies for endoscopic sinus surgery (ESS) and transsphenoidal approaches (TSAs) are uncommon. One potential source of epistaxis a er sphenoidotomy is the sphenopalatine artery's posterior septal branch (PSB). PSB injury, in addition to other factors, could increase the risk of sphenoid stenosis. The purpose of this study was to determine incidence of, and risks factors for, the following outcomes a er sphenoidotomy: PSB injury; postoperative epistaxis from the injured PSB; and sphenoid stenosis a er PSB injury. Methods:A single-institution, prospective case series was conducted based on 233 sphenoidotomies performed during ESS (n = 163) and TSAs (n = 70). Outcome measures included intraoperative PSB injury, postoperative epistaxis from the PSB, and sphenoid stenosis. Results:The incidence of PSB injury was 17.2% during ESSrelated sphenoidotomies, and 5.7% during TSA-related sphenoidotomies (p = 0.010). A er PSB injury during ESSand TSA-related sphenoidotomies (n = 32), there was 1 instance of epistaxis from the PSB (3.1%). Of the 161 ESSrelated sphenoidotomies, 6 developed complete or nearcomplete stenosis (3.7%), which was more likely to occur with smaller anterior sphenoid face dimensions (p = 0.001). PSB injury, revision sphenoidotomy, and other factors did not increase the risk of stenosis. None of the TSA-related sphenoidotomies stenosed completely. Median follow-up was 7 months.Conclusion: PSB injury occurred in 17.2% of ESS-related sphenoidotomies and 5.8% of TSA-related sphenoidotomies. A er PSB injury, postoperative epistaxis from the PSB was rare (3.1%). A er ESS-related sphenoidotomies, sphenoid stenosis was rare (3.7%), and was more likely to occur with smaller sphenoid dimensions, but not with PSB injury or other factors. C 2019 ARS-AAOA, LLC. How to Cite thisArticle: Kam J, Ahmad A, Williams A, Peterson EL, Craig JR. Postoperative epistaxis and sphenoid sinus ostial stenosis after posterior septal branch injury during sphenoidotomy. Int Forum Allergy Rhinol. 2019;9:842-849.A n endoscopic sphenoidotomy is performed by enlarging the natural ostium of the sphenoid sinus. Sphenoidotomy is performed during endoscopic sinus surgery (ESS) or skull base surgery for a variety of conditions, such

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“…5,6 Postoperatif gelişen epistaksisler çok mortal seyretmeyip transnazal kafatabanı cerrahisinde karşılaşılmaktadır. 7 Epistaksis, sfenopalatin arterin septal dalının yaralanmasına bağlı olabilir. Kanama postoperatif dönemdeki vaskülarize nazal mukozadan kaynaklanabileceği gibi sfenopalatin arterden abondan kanamalar da olabilir.…”

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“…9,10 Postoperatif epistaksisde, cerrahi travmaya maruz kalmış oftalmik ve özellikle internal maksiller arterin uç dalları posterior epistaksise neden olur. 7 Literatürde yer alan 457 olguluk bir endoskopik hipofiz adenomu serisinde epistaksis oranı %3,5 olarak belirtilmiştir. 7 Anatomik varyasyonlar dışında, endoskopik transnazal cerrahinin öğrenme sürecindeki deneyim eksikliği, hipertansiyon, antikoagülan ilaç ve madde kullanımının da epistaksisi kolaylaştırmasının mümkün olduğu öne sürülmüştür.…”

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Epistaxis After Endoscopic Transnasal Cranial Base Surgery: Clinical Analysis and Surgical Treatment

Çabuk¹,

Emengen²,

Çırak³

et al. 2018

Turkiye Klinikleri J Med Sci

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Endoskopik transnazal kafatabanı cerrahisinin komplikasyonları arasında yer alan ve tedavi sürecinin geç aşamasında görülen postoperatif epistaksisin sıklığı, ortaya çıkış zamanı ve risk faktörlerini ortaya koymak. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu çalışmaya, Eylül 1997-Aralık 2017 tarihleri arasında Kocaeli Üniversitesi Hipofiz Araştırma Merkezi-Nöroşirürji Kliniğinde endoskopik transnazal cerrahi uyguladığımız 2286 hastadan, postoperatif dönemde epistaksis nedeniyle kliniğimize kabul ettiğimiz ve acil cerrahiye aldığımız hastalar dahil edilmiştir. Bu çalışmada, epistaksisi olan 36 hastanın etiyolojisi, başvuru zamanları, risk faktörleri incelenmiş ve uygulanan kanama kontrolü cerrahisi değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Epistaksis ile hastaneye geliş günü, ilk ameliyattan ortalama 19,4 gün sonra olarak belirlenmiştir. Postoperatif erken dönemde (ilk 7 gün) cerrahiye alınan hasta sayısı 5'dir. En erken postoperatif 5. günde ve en geç 40. günde epistaksis gözlenmiştir. Otuz altı hastanın yedisi mikroadenom, üçü giant (dev) adenom ve 26'sı makroadenom nedeniyle opere edilmiştir. Dokuz hastanın anti-hipertansif ilaç kullanımı öyküsü bulunmaktadır. İlk operasyon notlarına göre 12 hastada intraoperatif sfenopalatin arter yaralanması mevcuttur. Epistaksisin cerrahi kontrolü sırasında 22 hastada sfenopalatin arter ve özellikle septal dalından olan kanamaların koterize edildiği rapor edilmiştir. S So on nu uç ç: : En çok ilişkili risk faktörlerini, endoskopik transnazal cerrahi sırasında sfenopalatin arter dallarında kanama meydana gelen ve ek olarak özgeçmişlerinde hipertansiyon öyküsü olan hastalar olarak belirlemiş bulunmaktayız.

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Incidence, risk factors and management of severe post-transsphenoidal epistaxis

Cited by 36 publications

References 22 publications

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

Postoperative epistaxis and sphenoid sinus ostial stenosis after posterior septal branch injury during sphenoidotomy

Epistaxis After Endoscopic Transnasal Cranial Base Surgery: Clinical Analysis and Surgical Treatment

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