[Points and Pitfalls of Deep Dural Suture].

Infection, especially meningitis, has always been a problem in transsphenoidal surgery(TSS)for tumors of the sella turcica, and it would not be an exaggeration to say that the history of improvements in transsphenoidal sinus surgery is the history of the battle against meningitis. Furthermore, around 1990, endoscopy was introduced to TSS, and TSS has been applied to median skull base tumors extending beyond the sella turcica and is being performed as extended TSS. As a result, TSS has also been performed for surgeries with large dural defects, and the deep dural suture method(DDSM)has been advocated mainly in Japan while TSS has been improved to prevent cerebrospinal fluid leakage. In this article, we will describe the transition and current method of skull base reconstruction in TSS and DDSM in detail, citing past literature and using videos of the methods used at our institution.