The endoscopic endonasal technique has become the modality of choice for the surgical management of cerebrospinal fluid (CSF) rhinorrhea in current rhinologic practice, a trend that reflects improvements in both peri-operative morbidity and recurrence rates. The precise surgical strategy adopted depends in part on the etiology as well as the size and site of the leak. Several factors mitigate against successful endoscopic repair, including anterior frontal recess and far anterolateral sphenoid sites, elevated body mass index (BMI), massive skull base defect, and a spontaneous etiology. We report the application of a novel technique involving the use of autologous bone pate and fascia, which precisely replicates the layered in situ anatomic characteristics and which in our opinion facilitates the endoscopic repair of even the most challenging sinonasal CSF leaks.
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