{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:35:26Z","timestamp":1791473726708,"version":"4.3.4"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The goal of this study was to evaluate the efficacy of watertight dural closure (WTDC) in preventing postoperative CSF leakage during extended endoscopic transnasal surgery (ETS) for skull base tumors, while preserving sinonasal quality by omitting the routine use of a nasoseptal flap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study included 28 patients who underwent ETS and experienced Esposito grade 3 CSF leakage at a single institution between June 2022 and June 2024. WTDC was performed using fascia lata grafts and various suturing techniques. Surgical videos and electronic medical records were reviewed to assess suturing times and postoperative outcomes. The efficacy of WTDC in preventing CSF leakage was evaluated, and the technical aspects of the procedure were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among the 28 patients (14 female, 14 male), WTDC was successfully achieved in 14 cases, with near-watertight closure in the remaining 14. The average suturing time decreased with experience, showing a trend of improved efficiency. No postoperative CSF leaks were observed, and 1 case of postoperative meningitis resolved without sequelae. Despite significant risk factors for CSF leakage, WTDC was effective in all patients without the routine use of lumbar drainage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>WTDC in ETS is a reliable method for preventing postoperative CSF leakage, particularly in complex skull base surgeries with high-risk factors. This technique avoids the complications associated with nasoseptal flap use, preserves sinonasal quality, and reduces the need for lumbar drainage, making it a valuable option for skull base reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.focus24701","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T06:52:03Z","timestamp":1738392723000},"page":"E5","source":"Crossref","is-referenced-by-count":5,"title":["Contribution of watertight dural closure to prevention of postoperative cerebrospinal fluid leakage in endoscopic transnasal surgery for intradural lesions"],"prefix":"10.3171","volume":"58","author":[{"given":"Harisinh","family":"Parmar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotaka","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"},{"name":"Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Shinya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoyuki","family":"Umekawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Nishijima","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The University of Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The University of Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunya","family":"Hanakita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhito","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"e97","article-title":"Long-term outcomes of non-vascularized multilayer fascial closure technique for dural repair in endoscopic transnasal surgery: efficacy, durability, and limitations","volume":"175","author":"Hasegawa H","year":"2023","unstructured":"Hasegawa H, Shin M, Shinya Y,  Long-term outcomes of non-vascularized multilayer fascial closure technique for dural repair in endoscopic transnasal surgery: efficacy, durability, and limitations. World Neurosurg. 2023;175:e97\u2013e107."},{"key":"b2","series-title":"World Neurosurg","first-page":"e1316","article-title":"Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multilayered fascia with a pressure-control spinal drainage system","volume":"114","author":"Hasegawa H","year":"2018","unstructured":"Hasegawa H, Shin M, Kondo K, Saito N. Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multilayered fascia with a pressure-control spinal drainage system. World Neurosurg. 2018;114:e1316\u2013e1324."},{"issue":"5","key":"b3","series-title":"ORL J Otorhinolaryngol Relat Spec","first-page":"289","article-title":"Multilayered closure of cerebrospinal fluid rhinorrhea with inlay fascia lata, autologous fat, and outlay fascia lata: our experience","volume":"78","author":"Ery\u0131lmaz MA","year":"2016","unstructured":"Ery\u0131lmaz MA, Ar\u0131c\u0131gil M, Alan MA. Multilayered closure of cerebrospinal fluid rhinorrhea with inlay fascia lata, autologous fat, and outlay fascia lata: our experience. ORL J Otorhinolaryngol Relat Spec. 2016;78(5):289\u2013295."},{"issue":"4","key":"b4","series-title":"J Neurosurg","first-page":"713","article-title":"Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions","volume":"107","author":"Cavallo LM","year":"2007","unstructured":"Cavallo LM, Messina A, Esposito F,  Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg. 2007;107(4):713\u2013720."},{"issue":"7","key":"b5","series-title":"Laryngoscope","first-page":"1133","article-title":"Algorithm for reconstruction after endoscopic pituitary and skull base surgery","volume":"117","author":"Tabaee A","year":"2007","unstructured":"Tabaee A, Anand VK, Brown SM, Lin JW, Schwartz TH. 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Rhinology. 2015;53(2):122\u2013128."},{"issue":"1","key":"b15","series-title":"J Neurol Surg B Skull Base","first-page":"65","article-title":"Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms","volume":"75","author":"Thompson CF","year":"2014","unstructured":"Thompson CF, Suh JD, Liu Y, Bergsneider M, Wang MB. Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms. J Neurol Surg B Skull Base. 2014;75(1):65\u201372."},{"issue":"3","key":"b16","series-title":"PLoS One","first-page":"e0248229","article-title":"Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery","volume":"16","author":"Lee IH","year":"2021","unstructured":"Lee IH, Kim DH, Park JS, Jeun SS, Hong YK, Kim SW. Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery. 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World Neurosurg. 2021;155:144\u2013149."},{"issue":"1","key":"b24","series-title":"Neurosurg Rev","first-page":"373","article-title":"Continuous dural suturing for closure of grade 3 leaks after tumor removal via an endoscopic endonasal approach","volume":"44","author":"Xue H","year":"2021","unstructured":"Xue H, Yang Z, Liu J, Wang X, Bi Z, Liu P. Continuous dural suturing for closure of grade 3 leaks after tumor removal via an endoscopic endonasal approach. Neurosurg Rev. 2021;44(1):373\u2013380."},{"issue":"5","key":"b25","series-title":"J Neurosurg","first-page":"1625","article-title":"Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery","volume":"131","author":"Ishikawa T","year":"2018","unstructured":"Ishikawa T, Takeuchi K, Nagata Y,  Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery. 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Neurosurg Focus. 2019;47(6):E21."},{"key":"b1","series-title":"World Neurosurg","first-page":"e97","article-title":"Long-term outcomes of non-vascularized multilayer fascial closure technique for dural repair in endoscopic transnasal surgery: efficacy, durability, and limitations","volume":"175","author":"Hasegawa H","year":"2023","unstructured":"Hasegawa H, Shin M, Shinya Y,  Long-term outcomes of non-vascularized multilayer fascial closure technique for dural repair in endoscopic transnasal surgery: efficacy, durability, and limitations. World Neurosurg. 2023;175:e97\u2013e107."},{"key":"b2","series-title":"World Neurosurg","first-page":"e1316","article-title":"Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multilayered fascia with a pressure-control spinal drainage system","volume":"114","author":"Hasegawa H","year":"2018","unstructured":"Hasegawa H, Shin M, Kondo K, Saito N. Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multilayered fascia with a pressure-control spinal drainage system. World Neurosurg. 2018;114:e1316\u2013e1324."},{"issue":"5","key":"b3","series-title":"ORL J Otorhinolaryngol Relat Spec","first-page":"289","article-title":"Multilayered closure of cerebrospinal fluid rhinorrhea with inlay fascia lata, autologous fat, and outlay fascia lata: our experience","volume":"78","author":"Ery\u0131lmaz MA","year":"2016","unstructured":"Ery\u0131lmaz MA, Ar\u0131c\u0131gil M, Alan MA. Multilayered closure of cerebrospinal fluid rhinorrhea with inlay fascia lata, autologous fat, and outlay fascia lata: our experience. 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