Abstract: Objective  To investigate the effect of tranexamic acid on intraoperative bleeding in patients with endoscopic resection of skull base chordoma and the safety of its application. Methods  Fifty-eight patients who underwent transendoscopic skull base chordoma resection from July 15, 2021 to October 27, 2022 at Beijing Tiantan Hospital, Capital Medical University were selected. The patients were divided into 30 cases in the tranexamic acid group （ group T） and 28 cases in the 0.9% sodium chloride injection control group  （ group C）  using the random number table method. In group T, tranexamic acid was administered at a loading dose of 20 mg/kg for 15 min at the time of surgical skin incision, followed by continuous pumping at 5 mg·kg^－1·h^－1 till the end of surgery or  till the drug was exhausted, and the total amount of drug did not exceed 2 g. In group control, saline was pumped at the same rate and in the same amount. Intraoperative blood loss, intraoperative and postoperative blood transfusion, duration of surgery, patient coagulation-related indexes at 24 h postoperatively, postoperative complications, unplanned secondary surgery, intensive care unit (ICU） stay, and length of hospital stay were recorded. Results  Intraoperative blood loss in group T was significantly less than that in group C ［4.2  (3.1, 10.0)  mL/kg versus 6.4  (4.3, 13.2)  mL/kg, P<0.05］. The intraoperative transfusion rate was not different with statistically significance between the two groups (P>0.05). However, the postoperative transfusion rate in the group T was significantly less than that in the control group (P<0.05). There were no statistically significant differences in the length of surgery, postoperative 24 h coagulation-related indexes, postoperative complications, unplanned secondary surgery, ICU stay or length of hospitalization between the two groups. Conclusion Intraoperative tranexamic acid in patients undergoing endoscopic resection of skull base chordoma was effective in reducing intraoperative bleeding and postoperative transfusion rates without increasing the incidence of postoperative complications.

Key words: skull base chordoma, tranexamic acid, intraoperative bleeding