Background: Skull base reconstruction after extended transsphenoidal surgery is essential to prevent postoperative cerebrospinal fluid leakage.

Methods: A novel and simple technique for skull base reconstruction termed "shoelace dural closure" was devised. The dura mater was closed with a fat graft using a continuous running suture with both ends of a double-armed suture.

Conclusions: The shoelace dural closure is an effective method for achieving watertight closure of the anterior skull base without the use of lumbar drains, fascia lata grafts, or nasoseptal flaps.