A, Dural repair using running-locking dural suture on taper or reverse-cutting, one-half-circle needle. Smaller-sized suture should be used. Use of suction with sucker and small cotton pledgets is essential to protect nerve roots while operative field is kept dry of cerebrospinal fluid. B, Single dural stitches can be used to achieve closure, each suture end being left long. Second needle is attached to free suture end, and ends of suture are passed through piece of muscle or fat, which is tied down over repaired tear to help achieve watertight closure. Whenever dural material is inadequate to allow closure without placing excessive pressure on underlying neural tissues, free graft of fascia or fascia lata or freeze-dried dural graft should be secured to margins of dural tear using simple sutures of appropriate size. C, For small dural defects in relatively inaccessible areas, transdural approach can be used to pull small piece of muscle or fat into defect from inside out, sealing cerebrospinal fluid leak. Central durotomy should be large enough to expose defect from dural sac. Durotomy is closed in standard watertight fashion.