内視鏡下経鼻的経蝶形骨洞手術後の遅発性鼻出血に対し塞栓術が有効であった1例

Usefulness of Endovascular Treatment for Delayed Massive Epistaxis Following Endoscopic Endonasal Transsphenoidal Surgery: A Case Report

Ⅰ．はじめに

　下垂体腺腫に対する経蝶形骨洞手術の合併症として，内頚動脈系，特に海綿静脈洞部の損傷による鼻出血は，稀ではあるが重要な合併症として報告されている^{1-3,5-7,9,10)}．一方，外頚動脈系の損傷による大量鼻出血に関する報告は少ない^4,8)．われわれは，経蝶形骨洞手術3週間後に多量の鼻出血で発症した外頚動脈損傷に対して，出血源であるsphenopalatine arteryの血管内治療（塞栓術）により止血・救命し得た症例を経験したので，文献的考察を加え報告する．

　We report here a case of massive nasal bleeding from the sphenopalatine artery three weeks after endonasal transsphenoidal surgery. This 66-year-old male suffered from massive nasal bleeding with the status of hypovolemic shock. Under general anesthesia,an emergent angiography revealed an extravasation from the sphenopalatine artery. Trans-arterial embolization using coil and n-butyl-cyanoacrylate (NBCA) was performed following the diagnostic angiography. Complete occlusion of the injured artery was achieved. The patient showed good recovery from general anesthesia. Delayed nasal bleeding after endonasal transsphenoidal surgery is a rare but important complication. The sphenopalatine artery and its branch are located in the hidden inferior lateral corner of the sphenoid sinus and may be injured during enlargement of the sphenoid opening. When massive delayed nasal bleeding follows transsphenoidal surgery and damage of the internal carotid artery has been ruled out,endovascular treatment of the external carotid artery should be considered.