Appropriate method of opening and closing the dura during endonasal transsphenoidal surgery: A technical report focusing on dural incision designs that considers dural tenting and dural suturing

Abstract Here, we aimed to present an effective dural incision design that considers subsequent dural tenting and suturing in endonasal transsphenoidal surgery (TSS). In 2011, we discontinued the conventional cruciate dural incision and changed the dural incision design to create a sufficiently large dural window and the shortest incision line to reduce the interdural gap after dural suturing simultaneously. Considering the type, size, direction of extension, uneven distribution, and anticipated resection degree of the tumour, we explored dural incisions of different shapes, including horizontal and vertical straight, T-, Y-, U-, and H-shaped ones. The large dural flaps were tented using 6 − 0 nylon. The edges of the dural flaps were gathered and routinely sutured at the end of the surgery to prevent cerebrospinal fluid leakage. The modified H-shaped incision design empirically reduced the interdural gap. Planar geometrical analysis showed that this was an appropriate dural incision design because it had the shortest incision line. Moreover, Y with an upside-down T-shaped incision was suitable for extended TSS, and sideways Y-shaped and straight incisions were suitable for cases in which a large window was unnecessary. The modified H-shaped dural incision is an optimal choice for effective dural flap tenting and suturing and should be routinely used in TSS.