Control of bleeding in extended skull base surgery

The resection of skull base neoplasms requires an intimate knowledge of basicranial vascular anatomy. Tumor distortion of surgical landmarks may increase the potential for inadvertent vascular injury with life-threatening intraoperative bleeding or delayed neurologic sequelae. Moreover, massive transfusion therapy may significantly alter the hemostatic mechanism in the perioperative period. On the basis of a review of hemorrhagic complications encountered in 154 consecutive skull base procedures, we describe techniques that are designed to avoid or efficiently control venous and arterial bleeding in extended skull base surgery. The management of complications resulting from blood replacement are reviewed.