ObjectiveTo explore the scientific comprehensive measures of intraoperative hemostasis for the management of hemorrhagic events due to different causes during endoscopic endonasal skull base surgery (EESBS).MethodsClinical data of 161 patients who received EESBS as the treatment for skull base benign tumor between Feb 2012 and April 2016 were analyzed retrospectively. They were divided into two groups. 87 patients who were hospitalized after Feb 2014 were included in the experiment group and managed with comprehensive measures including new hemostatic agents and techniques available for reducing intraoperative bleeding, such as Surgicel, Surgiflu/Surgifoam, lowtemperature plasma radiofrequency ablation. During preoperative and intraoperative assessment, patients at high risk of serious hemorrhagic complications should be recognized. Appropriate choices of different techniques for control of bleeding that relied mainly on the source of hemorrhage, the tissue involved, and the proximity of critical neurovascular structures were made. At the same time, 74 patients who were hospitalized before Feb 2014 were selected as control. The traditional medical gauze, pistolgrip or singleshaft electrocoagulator constituted the most important instruments available for reduction of intraoperative bleeding in EESBS. The volume of intraoperative blood loss, method of intraoperative hemostasis and operating time were recorded and statistically analyzed.ResultsAll patients underwent routine laboratory tests, skull base CT and MRI examinations, and some cases underwent skull digital subtraction angiography (DSA). In the control group, the volume of intraoperative blood loss was 50~2 100 ml with an average of 410±50 ml, and the operating time was 50~310 min with an average of 120±20 min. In the experimental group, the volume of intraoperative blood loss was 50~1 600 ml, an average of 280±50 ml, and the operating time was 45~220 min with an average of 90±20 min. The volume of intraoperative blood loss and operating time of the experiment group were significantly less than those of the control group, the differences were both statistically significant (both P<0.05). The volume of blood loss was related to the nature, site and blood supply of the tumor. Massive intraoperative bleeding was more likely to occur in tumors with abundant blood supply, deep location and complicated surrounding anatomical structures. The analysis showed no relation of blood loss volume with the size of tumor and the operating time.ConclusionFor the success of operation, the precondition is to master the threedimensional anatomy of the area of EESBS, especially the important vessels and nerves. Wisely using hemostatic new materials and techniques to reduce intraoperative bleeding and to maintain clear operation field is the key for successful operation.