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Technical principles of watertight dural closure in endoscopic endonasal surgery: How I do it
Hirotaka Hasegawa1, Yuki Kawaguchi2, Shunya Hanakita2
1Departments of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan. Hirotaka.hasegawa@ymail.ne.jp.
Background:
Watertight dural closure in deep endoscopic endonasal surgery remains technically demanding, largely due to restricted workspace and limited instrument maneuverability.
Method:
We describe a standardized, stepwise dural suturing technique based on three core principles: workspace optimization, adaptive grip strategy, and controlled needle handling. Detailed strategies for instrument selection, needle trajectory, and graft-based sealing are presented to enhance reproducibility.
Conclusion:
Systematic application of these principles enables reliable, watertight dural closure in deep endoscopic fields and may facilitate broader application of dural suturing as a reconstructive technique.
