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Updated: Jul 15, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Delayed massive epistaxis following endonasal transsphenoidal surgery.

H Nishioka¹, S Ohno, Y Ikeda

¹Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan.

Acta Neurochirurgica

|April 4, 2007

Summary

Delayed massive epistaxis is a rare complication following transsphenoidal surgery. Endovascular embolisation of the external carotid artery is a successful treatment for refractory cases when internal carotid artery damage is excluded.

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Last Updated: Jul 15, 2026

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Area of Science:

Neurosurgery
Otolaryngology
Vascular Surgery

Background:

Transsphenoidal surgery is a common approach for pituitary adenomas.
Delayed massive epistaxis is a rare but serious complication post-surgery.

Observation:

Two patients experienced severe epistaxis 8 and 13 days after transsphenoidal surgery for nonfunctioning pituitary adenoma.
Bleeding originated from arterial hemorrhage in the left posterior nasal cavity.
Conservative treatment and initial angiography were unsuccessful in identifying or controlling the bleeding.

Findings:

Endovascular embolisation of the external carotid artery successfully treated the epistaxis in both patients.
No complications occurred following the endovascular procedure.

Implications:

External carotid artery embolisation should be considered for severe delayed epistaxis post-transsphenoidal surgery.
This treatment is recommended when internal carotid artery injury is ruled out and conservative measures fail.