Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 4 2025 12 01 Non-watertight Dural Closure for Supratentorial Craniotomy Seems Enough: Technical Consideration 177 183 733224 10.22088/caspjs.2026.2080759.1044 EN Ramtin Pourahmad Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-1107-047X Hamed Ahamdian Department of Neurosurgery, Babol University of Medical Sciences, Babol, Iran 0000-0002-2251-1069 Mahdi Habibitabar Student Research Committee, Babol University of Medical Sciences, Babol, Iran Ebrahim Hejazian Department of Neurosurgery, Babol University of Medical Sciences, Babol, Iran 0000-0001-7383-4485 Journal Article 2025 12 13 Watertight dural closure (WTDC) is traditionally regarded as standard practice in craniotomy, although postoperative cerebrospinal fluid (CSF) may still leak through small gaps and predispose to extradural fluid collection, incisional fistula, infection, and wound dehiscence. Non-watertight dural closure (non-WTDC), defined as low-tension approximation of the dural edges without pursuit of complete closure, may mitigate pressure gradients across the dura and reduce these complications in included cases. We applied a standardized non-WTDC technique in 40 consecutive patients undergoing elective supratentorial craniotomy for a range of supratentorial lesions, including tumors, arachnoid cysts, ruptured and unruptured aneurysms, subdural hematoma, and arteriovenous malformations. Three patients developed postoperative CSF collections; one resolved with conservative management, and two were successfully treated with secondary conversion to WTDC. No patient developed an incisional CSF fistula, meningitis, or wound breakdown. In this early experience, non-WTDC after supratentorial craniotomy appeared sufficient and safe in appropriately included patients and may offer practical advantages by simplifying dural reconstruction and obviating the need for dural grafts or sealants during the primary closure. https://www.caspjs.com/article_733224_117fe2704e17fa79008cd9be58469d9d.pdf