Delayed epistaxis resulting from external carotid artery injury requiring embolization: A rare complication of transsphenoidal surgery: Case report
Delayed epistaxis resulting from external carotid artery injury requiring embolization: A rare complication of transsphenoidal surgery: Case report
复制标题
DOI：
10.1097/00006123-200007000-00052
复制
发表时间：
2000-07-01
期刊：
影响因子：
4.8
通讯作者：
Fraser, RAR
中科院分区：
文献类型：
--
作者：
Cockroft, KM;Carew, JF;Fraser, RAR
目标和重要性：颈外动脉分支外伤所造成的迟发性鼻出血是经蝶手术的一种罕见但潜在的严重并发症。我们报告两例严重，迟发性鼻出血的病人谁经历了经蝶手术。在这两种情况下，非侵入性治疗失败，需要血管内intervention.CLINICAL介绍：第一个病人，一个52岁的女性泌乳素瘤，进行了第二次经蝶切除术后18个月的第一次手术。患者在术后第15天因大量鼻出血再次入院。第二个病人，一个40岁的女性，经历了两次经蝶手术，相隔14年，促肾上腺皮质激素分泌腺瘤。术后第17天，患者因大量鼻出血再次入院。干预：两例患者最初均接受鼻球囊填塞治疗，但球囊回缩时发生复发性出血，需要转诊至介入放射科进行栓塞。在动脉造影时，发现第一例患者左侧上颌内动脉内侧分支有假性动脉瘤，随后进行了栓塞。第二例患者的动脉造影显示了一个异常扩张的中线分支的右上颌动脉在鼻中隔，这条血管闭塞在arteriography.CONCLUSION：迟发性大出血是一种罕见的，但显着的并发症经蝶手术。经蝶手术后出现迟发性鼻出血的患者应怀疑颈外动脉分支损伤，沿着颈内动脉损伤。难治性出血患者的血管造影应包括选择性颈外动脉注射。鼻腔前后填塞无效的鼻出血可通过血管内栓塞有效治疗。
OBJECTIVE AND IMPORTANCE: Delayed epistaxis resulting from trauma to branches of the external carotid artery is an infrequent but potentially serious complication of transsphenoidal surgery. We report two cases of severe, delayed epistaxis in patients who had undergone transsphenoidal surgery. In both cases, noninvasive treatment failed, necessitating endovascular intervention.CLINICAL PRESENTATION: The first patient, a 52-year-old woman with a prolactinoma, underwent a second transsphenoidal resection 18 months after the first surgery. She was readmitted on postoperative Day 15 with massive epistaxis. The second patient, a 40-year-old woman, had undergone two transsphenoidal surgeries, 14 years apart, for an adrenocorticotropic hormone-secreting adenoma. She was readmitted with massive epistaxis on postoperative Day 17.INTERVENTION: Both patients were initially treated with nasal balloon packing but experienced recurrent hemorrhage when the balloon was deflated, necessitating referral to the interventional radiology department for embolization. At arteriography, the first patient was found to have a pseudoaneurysm of the medial branch of the left internal maxillary artery, which was subsequently embolized. Arteriography in the second patient revealed an abnormally dilated midline branch of the right internal maxillary artery in the nasal septum; this vessel was occluded at arteriography.CONCLUSION: Delayed massive epistaxis is a rare but significant complication of transsphenoidal surgery. Injury to branches of the external carotid artery, along with injury to the internal carotid artery, should be suspected in patients who present with delayed epistaxis after transsphenoidal surgery. Angiography performed in patients with refractory bleeding should include selective external carotid injections. Epistaxis that is refractory to anterior and posterior nasal packing may be effectively treated with endovascular embolization.