Incidence of epistaxis after endoscopic pituitary surgery: Proposed treatment algorithm

Endoscopic transsphenoidal surgery for pituitary tumors is an increasingly common practice. Little has been reported on the incidence and treatment of postoperative epistaxis in this population. The aim of this study was to analyze the incidence of postoperative epistaxis and formulate a treatment algorithm based on our experience. We performed a case series with chart review. A total of 434 consecutive patients who had endoscopic transsphenoidal pituitary surgery were identified between April 2006 and November 2013. The incidence, clinical management, and outcomes were recorded. Based on the data, a treatment algorithm was constructed. Fifty-two percent of patients treated were female (mean age: 51.4 years). Tumor types included pituitary adenomas (73.3%), Rathke cleft cysts (19.6%), and other pathologies (6.7%). Eighteen patients reported an epistaxis event within 6 weeks of surgery (4.1%). Treatment included office cauterization in 7 (1.6%) patients, a return to the operating room for 5 (1.2%), nasal packing in 3 (0.7%), embolization in 2 (0.5%), and use of intranasal hemostatic agents in 1 (0.2%). Epistaxis after endoscopic pituitary surgery is concerning for rapid blood loss and risk of intracranial complications. Fortunately, in the absence of new cranial nerve palsy, most bleeding can be controlled with conservative measures such as topical cautery, hemostatic agents, and nasal packing. An algorithm is presented to help guide physician decision making in this clinical scenario.