Saturday, April 28, 2012

Day 28 of Cushing's Awareness: Arterial bleeds post op

Today I want to talk about some of the complications that can arise after Transsphenoidal surgery, specifically bleeding.  As with any surgery there is a risk of complications, infections and bleeding.  However, I do not feel that I was properly informed on exactly what to expect if something rare did indeed happen.  What happened to me with my arterial bleed was very, very rare.  It has been noted that it was possibly from my arteries being in a weakened state from Cushing's itself, but after doing some research I am not 100% sure this is accurate.

There are a lot of things that could have happened, but what happened to me on day 13 post op has actually been seen in several rare cases and was considered a delayed epistaxis because it did not happen during the surgery itself.  There is a possibility that my arteries were somehow injured during the procedure itself, but I am fairly confident that was not the case. However, I will never really know. They talk about the possibility of a carotid or sphenoplalatine artery injury and how there can be something called a false aneurysm or pseudoaneurysm that could have been to blame for what happened to me.

I am concerned by what I read in this PDF file because there were several instances where the bleeds happened again throughout a two to ten year span.  One patient died while trying to control the bleed.  I will not lie, I fear every single day that this artery will just start bleeding again.  I have such intense pressure inside of my head and sometimes something just feels really off inside of my sinuses like it did the night the bleed happened.  The PDF is a long read, but there is a lot of information pertaining to the rare arterial bleeds that can happen after this type of surgery.

I wish that I had known there was more of a possibility of this happening, but then again perhaps it's so rare they just don't mention it.  Honestly, knowing would have in no way prepared me for what I experienced that night.  It is one of those moments in my life that will forever plague me and make me feel feelings I really don't care to feel.  It was by far the most traumatic experience of my life.  Now, I have to really fear that it COULD happen again out of the blue.  Add that in with the possibility of needing sinus surgery which means they will be in that area again makes me an absolute mess.  I feel I could face any challenge life can hand me, but thinking about going through another artery bleed like I did that night makes me seriously want to crawl into bed and cry.  I don't want to ever go through that again.

I think that some type of angiography should have been done on me to really investigate the situation fully, yet it wasn't done.  I feel that I am a ticking time bomb.  I have not felt right since that bleed and what if there is still something massive just waiting to happen? I've said it before and I'll say it again, being rare and complicated stinks.

Arterial Injuries in Transsphenoidal Surgery for Pituitary Adenoma:
The Role of Angiography and Endovascular Treatment
J. Raymond, J. Hardy, R. Czepko, and D. Roy

PURPOSE: To define the role of angiography and embolization in the treatment of patients who
have arterial injuries during transsphenoidal surgery. METHODS: We retrospectively studied the
arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in
21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas.

RESULTS: Of the 21 patients who had complications, 17 had internal carotid injuries and four had
injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred
and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including
five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic
findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three
patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred
in patients who had complete carotid occlusion either from surgical packing or balloon embolization.
Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis
necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by
surgery (one patient) or by endovascular treatment (three patients) without complication. Three
deaths and five permanent deficits were directly related to the arterial injury or its treatment.

CONCLUSION: Profuse bleeding during or after transsphenoidal surgery should be investigated by
angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal
carotid injuries are best treated by carotid occlusion to prevent life-threatening epistaxis.

Index terms: Adenoma; Surgery, complications; Pituitary gland, neoplasms
AJNR Am J Neuroradiol 18:655–665, April 1997

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