2026 Proffered Presentations
S290: POSTOPERATIVE EPISTAXIS AFTER ENDOSCOPIC ENDONASAL APPROACHES: A 10-YEAR SINGLE-CENTER EXPERIENCE OF 1,100 CASES
Yu-Wen Huang, MD; Taipei Veterans General Hospital
Background: Postoperative epistaxis is a rare but potentially life-threatening complication of endoscopic endonasal approaches (EEA) for skull base lesions. While sporadic reports exist, large long-term single-institution data are limited. We reviewed our 10-year EEA cohort to determine the incidence, timing, bleeding sources, and reconstructive factors associated with postoperative hemorrhage.
Methods: We retrospectively analyzed 1,100 consecutive patients who underwent EEA for sellar and anterior skull base pathologies at our institution between January 2015 and May 2025, with emphasis on reconstructive techniques and related complications. Cases with postoperative epistaxis requiring endoscopic management were identified. Demographic data, pathology, reconstruction type, time to bleeding, suspected source, and clinical course were extracted from medical records.
Results: Postoperative epistaxis occurred in 13 patients (1.2%). The mean age was 53 years (range, 25–82), with a slight female predominance (7/13, 54%). Pathologies included pituitary adenoma (n=6), meningioma (n=2), craniopharyngioma (n=1), chondrosarcoma (n=1), suprasellar metastasis (n=1), meningocele (n=1), and other lesions (n=1). Reconstruction methods among these patients included middle turbinate graft (n=4), nasoseptal flap with fat graft (n=3), composite nasoseptal flap with fascia lata or MT graft (n=4), and others (n=2).
The mean time to hemorrhage was 13.5 days postoperatively (range, 0–28). Two patients bled on the day of surgery, while the majority (8/13, 62%) presented with delayed hemorrhage after postoperative day 7. Documented bleeding sources included the posterior septal artery (n=1), palatovaginal artery (n=1), tumor bed oozing (n=1), granulation tissue (n=1), and flap-related dehiscence or edge oozing (n=4). In five patients, no definitive arterial source was identified.
All patients achieved hemostasis after appropriate interventions, including nasal packing and endoscopic cauterization or clipping. No mortality occurred.
Conclusion: In our 1,100-case EEA cohort spanning 2015–2025, the incidence of postoperative epistaxis was 1.2%, with most events occurring in a delayed fashion within 2–3 weeks. The posterior septal and palatovaginal arteries, along with flap-related complications, were the most frequent sources. A systematic management pathway—prompt resuscitation, nasal packing, and targeted endoscopic control—provides effective hemostasis with favorable outcomes. Awareness of this complication and early intervention are essential to minimize morbidity.