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

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.