Endovascular Approach to Ruptured Sphenopalatine Artery: A Case Report and Literature Review

Author(s): Ram Saha, Abu Bakar Siddik, Masum Rahman, Samar Ikram, Cecile Riviere-cazaux, Abdullah Alamgir, Badrul Alam Mondal, Quazi Deen Mohammad, Sirajee Shafiqul Islam

Epistaxis is a rare complication following the endonasal approach of skull base surgery. Conservative methods like anterior and posterior nasal packing can be useful, but when these fail, a neuro-interventional technique can be used as a last-resort measure in cases of severe bleeding. The authors identify a 22-year-old female patient with recurrent epistaxis following resection of skull-base chordoma through an endonasal approach. An endovascular catheter digital subtraction angiogram identified the cause of epistaxis as a rupture of the left sphenopalatine artery branch of the left external carotid artery. A large dissecting aneurysm in the right intracerebral artery was also incidentally found. The unique co-occurrence of vascular problems was successfully managed by neuro-interventional techniques.