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Case Reports
. 2016 Dec 21;7(Suppl 41):S1053-S1056.
doi: 10.4103/2152-7806.196369. eCollection 2016.

Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization

Johanna Eneling  1 , Per M Karlsson  1 , Sandro Rossitti  1
Affiliations
Case Reports

Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization

Johanna Eneling et al. Surg Neurol Int. .

Abstract

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.

Keywords: Complication; epistaxis; pituitary adenoma; sphenopalatine artery; transsphenoidal surgery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Contrast-enhanced T1-weighted magnetic resonance imaging in coronal view showing a nonfunctioning pituitary adenoma. The tumor size was 2.5 × 2 × 2 cm, with suprasellar extension and compression of the optic chiasm
Figure 2
Figure 2
Digital subtraction angiography of the right common carotid artery in lateral view: (a) image in arterial phase showing a lesion in the sphenopalatine artery (arrow); (b) a later image showing arteriovenous shunt with venous filling (arrow) and extravasation of contrast agent (black arrow)
Figure 3
Figure 3
Digital subtraction angiography after microcatheterization of the right sphenopalatine artery showing the arteriovenous fistula before embolization: (a) Anterior posterior view; (b) lateral view
Figure 4
Figure 4
Digital subtraction angiography of the right common carotid artery in anterior posterior view: The arteriovenous fistula is occluded and the posterior septal branch of the sphenopalatine artery (arrow) is occluded
See this image and copyright information in PMC

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