Author(s)
Chester Griffiths, MD
Daniel Kelly
Garni Barkhoudarian, MD
Walavan Sivakumar
Frank Berry
Affiliation(s)
Pacific Neuroscience Institute-Pacific Head and Neck;
Abstract:
Postoperative and potentially life-threatening posterior sinonasal epistaxis can occur in endoscopic endonasal skull base surgery with a published incidence ranging from 0-7%. Our institution uniformly adopted a technique of bilateral sphenopalatine-posterior nasal artery preservation and septal olfactory strip preservation in 2011, publishing in 2014 our retrospective analysis of 174 patients. (1) The goal of this rescue flap technique is to avoid postoperative epistaxis and prevent anosmia; it is used in all cases when a nasoseptal or other pedicled flap is not used. Since August 2013 until June 2022 our center has performed an additional 879 endoscopic endonasal procedures on 795 pts, cumulative total of 1053 procedures on 956 patients. The cohort of tumor procedures will be presented. Nasoseptal flap was performed in 91 patients (11%) middle turbinate flaps 19 patients (2%) in current cohort analysis validating the ability to covert rescue flap technique into a formal nasoseptal flap as needed. Over this 11-year period, 2 incidences of arterial postoperative epistaxis occurred related to divergence from the standard rescue flap technique with accidental ligation of SPA-PNA for an overall incidence of epistaxis of 0.2%. Otherwise, there have been no episodes of major epistaxis while preserving and not ligating the sphenopalatine-posterior nasal artery vascular structures. Due to the potential for serious sequelae of postoperative posterior epistaxis, we recommend adoption of this technique to avoid delayed epistaxis in endoscopic endonasal surgery.
1. Griffiths CF et al: Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note Acta Neuro (2014) 156:1393-1401