Table of Contents
ISRN Surgery
Volume 2013, Article ID 191543, 11 pages
Review Article

Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

1Department of Anesthesiology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
2Department of Anesthesiology, Srinagarind Hospital, Faculty of Medicine, 123 Mitraparp Highways, Khon Kaen University, Khon Kaen 40002, Thailand
3Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
4Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
5Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA

Received 24 March 2013; Accepted 27 May 2013

Academic Editors: C. C. Chuang and A. Polydorou

Copyright © 2013 Cattleya Thongrong et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hemostasis is critical for adequate anatomical visualization during endoscopic endonasal skull base surgery. Reduction of intraoperative bleeding should be considered during the treatment planning and continued throughout the perioperative period. Preoperative preparations include the optimization of comorbidities and cessation of drugs that may inhibit coagulation. Intraoperative considerations comprise anesthetic and surgical aspects. Controlled hypotension is the main anesthetic technique to reduce bleeding; however, there is controversy regarding its effectiveness; what the appropriate mean arterial pressure is and how to maintain it. In extradural cases, we advocate a mean arterial pressure of 65–70 mm Hg to reduce bleeding while preventing ischemic complications. For dealing intradural lesion, controlled hypotension should be cautious. We do not advocate a marked blood pressure reduction, as this often affects the perfusion of neural structures. Further reduction could lead to stroke or loss of cranial nerve function. From the surgical perspective, there are novel technologies and techniques that reduce bleeding, thus, improving the visualization of the surgical field.