Hemostasis in Skull Base Surgery.

Having absolute hemostasis is crucial in skull base surgery, because bleeding decreases visualization and increases the risk of postoperative complications. Achieving hemostasis starts from the preoperative evaluation. A thorough clinical history and routine tests guide the surgeon to minimize bleeding risk preoperatively, and comprehensive study of preoperative images helps the surgeon to predict bleeding risk and to consider preoperative embolization in suitable cases. Many hemostatic agents are available to control intraoperative bleeding; understanding of their indications and properties is crucial to achieve hemostasis. Whether endoscopic or transcranial approach, microsurgical techniques to avoid and control bleeding are the same.