Introduction: Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur when a defect in the lateral skull base and dura mater occurs, allowing egress of cerebrospinal fluid into pneumatized spaces of the temporal bone, resulting in increased risk of meningitis, and often conductive hearing loss as well as clear rhinorrhea or otorrhea. While multiple surgical routes exist, the Middle Cranial Fossa (MCF) approach allows for comprehensive visualization of the entire middle fossa skull base, enabling robust repair of multiple defects.

Methods/Surgical Technique: This "Masters in Surgery" video presentation details the surgical management of a spontaneous CSF leak in a patient presenting with conductive hearing loss. The video highlights technical aspects and techniques of this approach, including the craniotomy, dural elevation, identification of tegmental dehiscence, and the meticulous application of hydroxyapatite bone cement for reconstruction.

Results/Discussion: Outcomes of this presentation will be to provide a detailed demonstration that the audience may apply to their practice, with high-quality operative video that highlights key aspects to safe and successful repair of CSF leaks via the middle cranial fossa approach. The presentation will also generate discussion among experts regarding improved care for patients with spontaneous CSF leaks.

Conclusion: The MCF approach with bone cement reconstruction is a highly effective, durable technique for the management of spontaneous CSF leaks. This video serves as a technical guide for neurotologists to refine their approach to complex skull base repairs to optimize patient outcomes.