Risk factors of epistaxis after endoscopic endonasal skull base surgeries

Area of Science:

• Neurosurgery
• Otolaryngology
• Vascular Surgery

Background:

• Epistaxis following endoscopic endonasal skull base surgery is multifactorial.
• Identifying risk factors is crucial for managing postoperative bleeding.

Purpose of the Study:

• To assess potential risk factors for postoperative epistaxis after endoscopic endonasal skull base surgery.
• To identify common bleeding sites in patients experiencing epistaxis.

Main Methods:

• A retrospective study of 762 patients undergoing endoscopic endonasal skull base surgery.
• Patients were categorized into epistaxis and no epistaxis groups.
• Multivariate logistic regression analyzed risk factors; bleeding sites were documented.

Main Results:

• The incidence of postoperative epistaxis was 2.6% (20 patients), occurring 6-30 days post-surgery.
• Arterial hypertension (OR=3.394) and preoperative systolic blood pressure (SBP) (OR=1.035) were significant predictors.
• The left posterior septal artery (PSA) was the most frequent bleeding site (62.5% of cases).

Conclusions:

• Arterial hypertension and elevated preoperative SBP are associated with epistaxis post-skull base surgery.
• The left posterior septal artery is a primary source for bleeding requiring re-exploration.
• Effective management, including bipolar cauterization, resolved recurrent epistaxis.