title: Incidence, risk factors and management of severe post-transsphenoidal epistaxis.
abstract: Among the major complications of transsphenoidal surgery, less attention has been given to severe postoperative epistaxis, which can lead to devastating consequences. In this study, we reviewed 551 consecutive patients treated over a 4 year period by the senior author to evaluate the incidence, risk factors, etiology and management of immediate and delayed post-transsphenoidal epistaxis. Eighteen patients (3.3%) developed significant postoperative epistaxis - six immediately and 12 delayed (mean postoperative day 10.8). Fourteen patients harbored macroadenomas (78%) and 11 of 18 (61.1%) had complex nasal/sphenoid anatomy. In the immediate epistaxis group, 33% had acute postoperative hypertension. In the delayed group, one had an anterior ethmoidal pseudoaneurysm, and one had restarted anticoagulation on postoperative day 3. We treated the immediate epistaxis group with bedside nasal packing followed by operative re-exploration if conservative measures were unsuccessful. The delayed group underwent bedside nasal hemostasis; if unsuccessful, angiographic embolization was performed. After definitive treatment, no patients had recurrent epistaxis.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: De Los Reyes
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: bgross1@partners.org.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rincon-Torroella
authors.affiliation: Department of Otolaryngology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000379:methods; D004844:Epistaxis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006487:Hemostasis; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013100:Sphenoid Bone / Q000601:surgery*; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Endoscopic; Epistaxis; Management; Microscopic; Pituitary; Risk factors; Transsphenoidal