Incidence and management of epistaxis after endoscopic skull base surgery

Endonasal endoscopic surgery continues to gain acceptance as a minimally invasive, effective approach for benign and malignant pathology of the paranasal sinuses and skull base. Postoperative epistaxis could potentially result in rapid and devastating consequences due to hemorrhage. Our objective was to assess the incidence and causes of epistaxis after endoscopic skull base surgery.

Retrospective review of patients undergoing endoscopic skull base surgeries from 2007 to 2012. The main outcome measure was epistaxis requiring a visit to a hospital or clinic occurring within 30 days of surgery.

In our cohort of 330 consecutive patients, 10 (3%) experienced postoperative epistaxis, including 3 who had multiple episodes (14 events). A majority of the patients were controlled with packing in the emergency room (8/14 events). One patient required chemical cautery and 5 required control in the operating room. The only patient characteristic that reached significance was abstinence from alcohol (p value = 0.04). However, patients with epistaxis were more likely to be male, older and have hypertension.

This study confirms that the risk of epistaxis after endoscopic skull base surgery is low and similar to sinonasal surgery for inflammatory conditions.