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tis before and after closure of CSF leaks and the use of intrathecal application of sodium fluorescein to identify CSF leaks.Methods: Retrospective study on 39 patients who underwent endoscopic skull base surgery from July 1991 to July 2001.Results: Thirty-nine patients had 41 endoscopic anterior skull base defects of various origins: idiopathic (n ϭ 10), benign tumor (n ϭ 12), posttraumatic (n ϭ 14), and iatrogenic (n ϭ 4). Sodium fluorescein was used intrathecally in all patients to identify the defect. It was helpful in 41/41 cases. Fifteen patients had suffered bacterial meningitis before surgery. Mean follow-up was 56 months (range, 8-120). Defects were located at cribiform plate (n ϭ 21), ethmoidal roof (n ϭ 12), and sphenoid sinus (posterior wall, n ϭ 3; lateral wall, n ϭ 5). Lyophilized dura (n ϭ 11) or fascia lata (n ϭ 30) was used to reconstruct the defect in an "underlay" technique (between the dura and the bony floor of the skull base) and then covered with free mucosal grafts. The size of the defects ranged from millimeters to the complete skull base of one side. Closure was achieved in 40 of 41 cases. One case with a meningoencephalocele of the lateral sphenoid wall developed a recurrent CSF fistula associated with meningitis.Conclusions: Lyophilized transplants in an "underlay" position together with free mucosal grafts seem to provide an excellent long-term result with no recurrent episodes of ascending meningitis unless a CSF leak appears. Intrathecal sodium fluorescein application helps to identify the CSF leak and to confirm its watertight closure. No complications were observed secondary to the use of fluorescein.