Delayed postoperative epistaxis from the posterior lateral nasal branch of the sphenopalatine artery after endoscopic endonasal approach: Case report

Postoperative delayed epistaxis is a rare but serious complication following endoscopic endonasal surgery for pituitary adenoma. It usually originates in the septal branch of the sphenopalatine artery (SPA), whereas we experienced a case of postoperative delayed epistaxis from the posterior lateral nasal branch of the SPA after endoscopic endonasal approach with middle turbinectomy. A 38-year-old woman underwent an endoscopic transsphenoethimoidal approach combined with middle turbinectomy for the removal of recurrent atypical growth hormone-secreting adenoma invading to the left cavernous sinus. She suddenly showed delayed massive epistaxis two weeks after surgery. Emergency endoscopic endonasal surgery under general anesthesia confirmed bleeding from the posterior lateral nasal branch of the SPA. To our knowledge, this is the first case reporting that delayed epistaxis occurred due to the bleeding from the posterior lateral nasal branch of the SPA after endoscopic endonasal approach for pituitary adenoma. It is important for neurosurgeons to be aware of the possibility of delayed epistaxis from injury of the posterior lateral nasal branch of the SPA during endoscopic endonasal approach with middle turbinectomy to the lateral nasal wall