Traumatic anterior skull base (ASB) dural defect is associated with a high risk of cerebrospinal fluid (CSF) leak, which is a potentially morbid complication of craniofacial trauma.1, 2, 3, 4 CSF leak runs a significant risk of life-threatening meningitis, necessitating a timely diagnosis and successful surgical treatment.5 Close watertight closure of cranial base dural defect is critical but challenging in the surgical treatment of CSF leak.4,6 Surgical closure of traumatic ASB dural defect is especially difficult and time-consuming because it is usually deeply located and large in size.7 Traditional techniques of skull base reconstruction include a multilayered approach comprising vascularized flap and various autologous or synthetic materials via open and/or endoscopic surgical approaches. A significant limitation of the traditional techniques is that despite the surgical techniques used (even the standard vascularized flap), high rates of failed primary repair and persistent CSF leak range from 10% to 27%, aggravating the risk burden of meningitis.4,5,8

Here, the authors present the trans-defect underlay watertight duraplasty (TDUWD) technique for traumatic ASB dural defect. The outcomes following the use of this technique are presented.