PURPOSE: To define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery. METHODS: We retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas. RESULTS: Of the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment. CONCLUSION: Profuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.
PURPOSE: To define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery. METHODS: We retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas. RESULTS: Of the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment. CONCLUSION: Profuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.
Authors: J R Anderson; N Antoun; N Burnet; K Chatterjee; O Edwards; J D Pickard; N Sarkies Journal: J Neurol Neurosurg Psychiatry Date: 1999-06 Impact factor: 10.154
Authors: Jackson A Gondim; Joao Paulo C Almeida; Lucas Alverne F Albuquerque; Michele Schops; Erika Gomes; Tania Ferraz; Wladia Sobreira; Meissa T Kretzmann Journal: Pituitary Date: 2011-06 Impact factor: 4.107
Authors: Daniela Iancu; Cheemum Lum; Muhammad E Ahmed; Rafael Glikstein; Marlise P Dos Santos; Howard Lesiuk; Mohamed Labib; Amin B Kassam Journal: Interv Neuroradiol Date: 2015-05-26 Impact factor: 1.610