Background: Surgeon’s depend to a large degree on the amount of blood loss and a clear view of the surgical field, when conducting endoscopic procedures in order to achieve satisfactory outcomes. The anesthesiologist’s choice of method for the induction and maintenance of anesthesia plays a major role in achieving this goal.

Objectives: This study was performed in order to compare the two most well-known methods in this regard; total intravenous anesthesia (TIVA) and venous inhalational mixed anesthesia (VIMA).

Patients and Methods: This study included the endoscopic management of 89 patients with cerebrospinal leakage (CSF leakage) covering a period of nine years (1999-2008) for whom a subarachnoid injection of fluorescein was first administered, and afterwards they were maintained under general anesthesia using two distinct methods; propofol-remifentanil versus isoflurane–remifentanil (inhalational or intravenous). During the operation, hemodynamic indices, blood loss, and surgeon’s satisfaction, were assessed and compared between the two groups.

Results: Endoscopic management and autografts were successful in repairing anterior skull defects in 90% of cases. Regarding the surgeon’s satisfaction level, and hemodynamic stability no significant difference between the two groups was observed (P > 0.01).

Conclusions: Both isoflurane and propofol in combination with remifentanil afford optimal surgical conditions with regard to hemodynamic parameters and the satisfaction of the surgeon with the surgical field.\r\n