Subcranial transnasal repair with free autologous grafts by the combined overlay and underlay techniques using the endoscope or surgical microscope is a safe and successful method of treating CSF leaks, provided that the CSF leak is precisely located and the site can be reached with the endoscope or surgical microscope.

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Objective: To demonstrate the flexibility, adaptability, and efficacy of endoscopic endonasal removal of the inferior half of the middle turbinate in a cadaveric study and in surgery for the treatment of different sphenoid sinus and skull base lesions. Methods: Anatomic Cadaveric Study: Five adult cadaveric heads were studied. Six nostrils of 3 cadavers were studied endoscopically after the lower half of the middle turbinate was removed. Two adult cadaveric heads underwent bilateral paraseptal sagittal sectioning and were studied after the lower half of the middle turbinate was removed. Sixty-five patients with different sphenoid sinus and skull base-related lesions were treated through this surgical approach. Results: This approach increased surgical exposure, decreased tubular vision, and offered wider anatomic panoramic orientation with 0-degree and angled endoscopes. In the surgical group, there were no major intra-or postoperative complications. The approach improved exposure, accessibility to the lesion, and permitted good hemostasis, tumor resection, and repair of the skull base defect. Conclusion:The current approach provides a wide surgical field without increasing morbidity. It avoids unnecessary trauma to the other nostril as occurs in a binostril approach. The harvested piece of turbinate tissue is an excellent source of donor material for