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  • Endovascular management of a sphenopalatine artery pseudoaneurysm: a rare cause of delayed intractable epistaxis following endoscopic transsphenoidal pituitary surgery

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Case Reports: Learning from unexpected outcome (positive or negative)
Endovascular management of a sphenopalatine artery pseudoaneurysm: a rare cause of delayed intractable epistaxis following endoscopic transsphenoidal pituitary surgery
  1. Sreehari Nirmala Ramachandran,
  2. Ayyadurai Retnathankom,
  3. Ishant Rege and
  4. Krishna Tej Reddy
  1. Department of Neurosurgery, Amrita Institute of Medical Sciences, Cochin, India
  1. Correspondence to Dr Ishant Rege; drishantrege{at}gmail.com

Abstract

Vascular injuries during pituitary surgery are feared as they can lead to serious disability and can be life threatening. We are describing a case of severe intractable epistaxis following endoscopic transnasal transsphenoidal surgery for pituitary tumour due to a sphenopalatine artery pseudoaneurysm which was successfully managed using endovascular embolisation techniques. Very few cases of sphenopalatine artery pseudoaneurysm following endoscopic nasal surgery have been described. A middle aged male patient with a pituitary macroadenoma underwent endoscopic transsphenoidal pituitary surgery and returned to us after 3 days of discharge with severe epistaxis. Digital subtraction angiography showed contrast leakage and left sphenopalatine artery pseudoaneurysm. Glue embolisation of the distal sphenopalatine branches and pseudoaneurysm was done. Good occlusion of pseudoaneurysm was seen. Such a diagnosis for epistaxis following endoscopic transnasal surgery should be borne in mind, so prompt treatment can be planned to avoid life threatening complications.

  • neuroimaging
  • vascular surgery
  • neuroendocrinology
  • neurological injury

https://doi.org/10.1136/bcr-2022-253998

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    Footnotes

    • Contributors Drafting of the text—IR, sourcing and editing of clinical images—SNR, investigation results—IR, drawing original diagrams and algorithms—KTR and critical revision for important intellectual content—SNR, AR.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.