Bleeding is a major factor that hinders visualization in head and neck surgery and is a risk factor for intraoperative complications and perioperative morbidity. Endoscopic approaches also pose significant technical challenges to managing expected intraoperative bleeding and vascular injury. The approach for this publication in Otolaryngologic Clinics is to provide clinically relevant information in a problem-based manner that encompasses assessment to identify patients with a high risk for vascular complications, pre-operative, intra-operative and post-operative strategies to manage expected bleeding and major vessel injury during endoscopic sinus and skull base surgery for inflammatory and neoplastic diseases. Clinically relevant anatomy, physiology, pharmacology, and surgical and interventional radiology techniques to manage bleeding are outlined and an algorithm for management of major vessel injury such as internal carotid artery injury is presented. Because skull base surgery is generally undertaken as a team approach, this information is relevant to the subspecialized ENT surgeon from rhinology or head and neck specializations, to neurosurgeons, to interventional radiologists, and to neurophysiologists who monitors intraoperative cerebral and cranial nerve activity for these operations. Carl Snyderman leads this issue with Harshita Pant and has composed topics and assembled an expert group of practitioners to provide information. The reader will find this a novel, focused, and indispensable resource on all issues of hemostatis in head and neck surgery.