A reproducible pull-through technique using a ligature passer for dural tenting

Background: Dural tenting is performed to reduce the risk of postoperative epidural hematoma; although its routine use remains controversial, it continues to be widely practiced. Suture passage through drill holes in the bone flap is conceptually simple but can be technically cumbersome, often requiring precise alignment and repeated attempts. We describe a pull-through technique using a ligature passer to enable controlled and reproducible suture passage. Methods: A single-use wire ligature passer (LAPA-HER-CLOSURE) was used to retrieve dural sutures through drill holes in the bone flap. The device was inserted from the outer table toward the inner surface, where a loop mechanism was deployed to capture the suture and withdraw it through the drill hole. This technique replaces blind threading of a flexible suture with controlled retrieval using a rigid device. Results: The technique eliminates blind suture passage and reduces repeated attempts and unnecessary manipulation. It enables stable, reproducible suture passage through drill holes. Owing to its intuitive mechanical design, the technique requires minimal specialized training. Although the impact on overall operative time may be limited, it may reduce the time required for dural tenting, particularly when dural tenting is performed at multiple sites. Conclusion: This pull-through technique using a ligature passer is a simple and practical refinement that facilitates reliable suture passage and simplifies bone flap handling.