International Rhinologic Society Rhinology 0300-0729 2025 11 30 Assessing the need for bed rest after anterior skull base reconstruction: insights from a multicentre retrospective observational study EN X. Yan Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China L. Wang Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China J. Liu Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China H. Zhang ENT Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China W. Wei Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China L. Yu Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China W. Li ENT Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China H. Yu ENT Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China Z. Wang Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China Y. Jiang Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China Journal Article 3354 10.4193/Rhin25.123 Skull base reconstruction is a critical component of endoscopic endonasal skull base surgery (EESBS). Bed rest remains an indispensable element of post-operative care, which should be carefully considered for reducing the risk of cerebrospinal fluid (CSF) leaks and enhancing surgical outcomes (1, 2). However, the necessity of bed rest continues to be controversial as indicated by the expert consensus on perioperative management of skull base reconstruction, due to a lack of high-quality evidence to support its effectiveness (1-4). This study focuses exclusively on anterior skull base reconstruction, which is frequently employed in EESBS but has not been sufficiently investigated. In this study, we retrospectively collected patient data from three skull base centres to analyse the impact of bed rest on the occurrence of post-operative CSF leakage.