Learning Objectives: 1. Describe the typical clinical presentation of CSF leaks and encephaloceles 2. Understand the advantages and disadvantages of imaging modalities to diagnosis and locate CSF leaks and encephaloceles 3. Compare surgical approaches and techniques to repair CSF leaks and encephaloceles.

Spontaneous cerebrospinal fluid (CSF) leaks and encephaloceles are uncommon but important conditions to recognize because of the risk for meningitis. Typical symptoms include a chronic effusion, tympanostomy tube otorrhea, or recurrent meningitis. Once a CSF leak is suspected, diagnosis may be challenging and is aided by laboratory testing of the fluid and imaging. Surgical approaches depend on multiple factors including age, location of the defect, and surgeon's preference. In this case-based presentation, the challenges of diagnosing and managing CSF leaks and encephaloceles will be discussed. Advantages and disadvantages of imaging modalities will be compared. Finally, surgical approaches including middle fossa craniotomy, transmastoid, and combination approaches will be examined.