A novel approach to addressing intercavernous sinus bleeding: Preoperative onyx embolization in the endoscopic endonasal approach for craniopharyngioma resection

Background: Hemorrhage originating from the intercavernous sinuses during transsphenoidal approaches for skull base injury is a common occurrence, but it can be easily controlled. However, in specific cases, it may necessitate suspending the surgery or result in hemodynamic instability.

Case description: We present the case of a 7-year-old female patient who underwent transsphenoidal endoscopic endonasal for craniopharyngioma resection. The patient's parents gave consent for the procedure. During the procedure, significant intraoperative bleeding occurred, which was necessary to stop the resection. After the surgery, cerebral angiography was performed, which identified a prominent anterior intercavernous venous sinus as the source of the bleeding. A successful embolization using onyx was performed, leading to a satisfactory postoperative recovery without any complications. The patient then underwent a second surgical intervention for the resection of the craniopharyngioma through an endoscopic endonasal transsphenoidal approach. This procedure achieved a complete resection of the lesion without complications, and the patient experienced an adequate postoperative recovery.

Conclusion: The objective of this case is to describe a previously unreported technique involving onyx embolization for controlling prominent bleeding from the intercavernous sinus and as a presurgical embolization method to reduce the risk of bleeding during endoscopic endonasal surgery for resection of a craniopharyngioma.