Diagnosis and treatment of severe epistaxis after endoscopic skull base surgery

Objective To summarize the causes, treatment and prognosis of severe epistaxis after transnasal endoscopic skull base surgery. Methods and Results There were 12 patients with delayed severe epistaxis after transnasal endoscopic skull base surgery from February 2007 to January 2018. Surgical methods included endoscopic electrocoagulation hemostasis in 7 cases (7/12), DSA-assisted endoscopic electrocoagulation hemostasis in one case (1/12), DSA-assisted superselective arterial embolization in 3 cases (3/12), and DSA-assisted superselective arterial embolization combined with endoscopic electrocoagulation hemostasis in one case (1/12). Successful hemostasis occurred in 11 cases, and one case died. Patients were followed up for (17.21 ± 3.42) months without epistaxis recurrence. Conclusions Epistaxis mainly occurs over 7 to 14 d after transnasal endoscopic skull base surgery. The choice of operation methods is related to the location of bleeding and responsible artery. Endoscopic electrocoagulation hemostasis is an effective method without serious complications. Patients with internal carotid artery (ICA) pseudoaneurysms can be cured by endoscopic electrocoagulation hemostasis plus arterial embolization. DOI: 10.3969/j.issn.1672-6731.2019.04.00