BACKGROUND: The minimal anterior posterior combined (MAPC) transpetrosal approach is a valuable technique for accessing petroclival lesions with supra-infratentorial extensions. However, dural reconstruction following this approach presents significant challenges owing to subtemporal and presigmoid dural, and transtentorial incisions, dural shrinkage resulting from coagulation, and spatial constraints. METHODS: This study retrospectively examined 25 patients who underwent MAPC transpetrosal approach between 2022 and 2024. We employed a simplified method of dural reconstruction utilizing a fat graft and a sternocleidomastoid muscle-periosteum-temporal fascia flap without suturing. An absorbable PGA material was fixed along the flap using fibrin glue to reinforce the sealing of the dura (question no.4, reviewer #1). The evaluation was conducted with a focus on subcutaneous CSF collection based on postoperative MRI findings, and the strategies employed to address this complication were assessed. RESULTS: Of the 25 cases examined, 16 showed no evidence of subcutaneous CSF accumulation (grade 0). Two patients were classified as grade 1, while seven patients exhibited grade 2 subcutaneous CSF collection. None of the patients experienced CSF leakage through the surgical incision nor did they develop CSF rhinorrhea or otorrhea. All instances of S-CSF accumulation resolved spontaneously within 2-6 weeks, without requiring surgical intervention. Only one patient with a history of repeat surgery required CSF diversion via a lumbar drain postoperatively. CONCLUSION: The simple dural reconstruction method using autologous fat graft and sternocleidomastoid temporal fascia flap demonstrated promising results in term of preventing CSF-related complications following the MAPC transpetrosal approach.