Incidence and Management of Epistaxis after Endoscopic Skull Base Surgery

Objective: The purpose of this study is to assess the incidence and causes of postoperative epistaxis after endoscopic skull base surgery.

Setting: This study was conducted at an academic tertiary care medical center.

Patients and Methods: A total of 305 consecutive endoscopic endonasal skull base surgeries were performed at a single tertiary care institution from 2007 to 2011. Surgery was performed for a wide variety of benign and malignant pathologies including sellar tumors (245), meningiomas (17), clival chordomas (9), craniopharyngiomas (5), and others (29). Patient-related characteristics (age, sex, diagnosis, comorbidity level, medical history,; medications), operative data, and the incidence and management of postoperative epistaxis were recorded over a 4-year period.

Results: The incidence of postoperative epistaxis was 2.5% (eight episodes) in five patients (1.6%). Two patients had a history of hypertension. Median time to epistaxis was 8 days (range, 4–13 days). Three patients were managed successfully with repeat nasal packing alone, one required cautery of the sphenopalatine artery, and one patient was taken to the operating room for diffuse mucosal bleeding. The site of bleeding was identified in 2/8 episodes (25%). No patient required blood transfusion or embolization.

Conclusions: Epistaxis after endoscopic skull base surgery is infrequent, with an incidence similar to endoscopic surgery for inflammatory conditions. Despite a potential for severe postoperative hemorrhage, the current study demonstrates that bleeds are generally mild, can be treated with nasal packing or simple cautery, and usually occur in the early perioperative period.