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Endonasal skull base surgery (see Fig. 1 
Fig. 1
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Sagittal head MRI revealing the skull base anatomy and relative positioning of the nasal passage and skull base

Fig. 1
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Sagittal head MRI revealing the skull base anatomy and relative positioning of the nasal passage and skull base

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) has proven to be a safe, effective, and significantly less invasive surgical approach when compared to open, highly invasive techniques [1]. Nevertheless, one initial difficulty with this minimally invasive approach has been postoperative leakage of cerebrospinal fluid (CSF) [2]. While the incidence of postoperative CSF leaks are low (<1%), the potential consequences are severe and include meningitis, brain abscess, neurologic deficits, brain hemorrhage, and death [1].

Depending on the nature of the surgery, violation of the skull base may be inevitable and is not uncommon during...

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