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Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization.
Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)In: Surgical Neurology International, ISSN 2152-7806, E-ISSN 2152-7806, Vol. 7, no Suppl 41, S1053-S1056 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Vascular injuries in transsphenoidal surgery for pituitary adenomas are uncommon but can result in serious disability or death.

CASE DESCRIPTION:

A 46-year-old man, who underwent resection of a pituitary adenoma with suprasellar extension via a transsphenoidal approach, presented with massive epistaxis five days postoperatively. Angiography revealed an arteriovenous fistula (AVF) between the right sphenopalatine artery and a deep vein draining to the right internal jugular vein, as well as contrast agent extravasation at the fistula point. The AVF was catheterized and successfully occluded with N-butyl-2-cyanoacrylate.

CONCLUSIONS:

Transsphenoidal pituitary surgery can be complicated by massive epistaxis from a lesion of a small branch of the external carotid artery. Airway protection through intubation and investigation with conventional digital subtraction angiography is recommended. The treatment of choice is endovascular embolization because it can be done immediately at the angiography suite.

Place, publisher, year, edition, pages
Medknow Publications, 2016. Vol. 7, no Suppl 41, S1053-S1056 p.
Keyword [sv]
Complication; epistaxis; pituitary adenoma; sphenopalatine artery; transsphenoidal surgery
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-136915DOI: 10.4103/2152-7806.196369PubMedID: 28144482OAI: oai:DiVA.org:liu-136915DiVA: diva2:1092156
Available from: 2017-05-01 Created: 2017-05-01 Last updated: 2017-05-30

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Eneling, JohannaKarlsson, Per M.Rossitti, Sandro
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