Watertight closure of the dura following transsphenoidal operations for pituitary adenoma or hypophysectomy and following transclival operations for paraclival tumors has been technically very difficult. This is true both immediately after the initial approach and later for the treatment of delayed cerebrospinal fluid leakage. An innovative practical technique and special suture-tying instruments and needle designed by the principal author for this purpose have greatly facilitated this procedure. This technique has been applied to both direct dural closure and dural patching with watertight dural closure. The technique is also widely applicable for closing (or suturing) the dura following any procedure through a small opening, such as the dural tears occasionally encountered during lumbar or cervical discectomy, or tacking the tentorium during a craniotomy. The technique and suture-tying instruments are described in detail.
