The retrosigmoid craniotomy is a versatile surgical approach that provides a natural corridor to the cerebellopontine angle (CPA). It is a workhorse in the neurosurgical armamentarium used to treat a wide range of pathologies. Cerebrospinal fluid (CSF) leak remains a concern after posterior fossa approaches, with a reported prevalence of 0–22 % [1], [2]. Unlike more midline approaches, there is a comparative paucity of robust superficial layers in the retrosigmoid region that provide additional closure integrity. Achieving a “watertight” dural closure after retrosigmoid approaches has been the accepted neurosurgical maxim to minimize CSF leaks in such scenarios [3]. However, as the result of many surgical factors including bipolar cauterization of dural edges for hemostasis, desiccation under the operative microscope lamp, and intended dural resection, watertight approximation of the dura is often unachievable. As a result, a host of closure materials and strategies have been proposed to achieve dural layer closure to varying degrees of success. In our practice, we find that much of the pathology encountered in the CPA can be accessed via a smaller “keyhole” approach and that adequate closure can be obtained in a standardized fashion without the need for obtaining a watertight dural closure. In this study we review our series of keyhole retrosigmoid craniotomies, describe our simple, standardized method of closure, and examine outcomes and rates of CSF leak.