Figure 1: Harvey Cushing illustrated the technique of dural closure for a subtemporal decompression in 1909. At that time, intradural surgery was considered risky and reliable tumor localization was not consistently possible. Subtemporal decompression was used to alleviate intracranial tension until more localizing signs developed. Note the use of a scalp tourniquet as a rudimentary method of hemostasis (Illustration courtesy of the Cushing Brain Tumor Registry at Yale University).
Dural opening and closure techniques are important to avoid restricted operative corridors and postoperative complications such as cerebrospinal fluid (CSF) leakage and wound breakdown. Attention to detail is crucial to minimize disappointing results and readily preventable complications.