Technical principles of watertight dural closure in endoscopic endonasal surgery: How I do it.

Hasegawa, Hirotaka; Kawaguchi, Yuki; Hanakita, Shunya · Acta Neurochir (Wien) · 2026

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Abstract

Watertight dural closure in deep endoscopic endonasal surgery remains technically demanding, largely due to restricted workspace and limited instrument maneuverability. 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. 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.