Objective To investigate the surgical indications and strategy for transcranial surgery for repair of cerebrospinal fluid rhinorrhea.Methods From March 2011 to May 2013, seven patients with cerebrospinal fluid rhinorrhea who were unresponsive to conservative therapy underwent a transcranial surgical repair in our hospital. The sugar content of leaking cerebrospinal fluid was measured and nasal endoscopy was performed to confirm the cerebrospinal fluid leakage. Thin multislice head CT scan and parallel two-dimensional coronal reconstruction were used to confirm the position of leak port. Forehead coronal incision was applied in all patients. Patching for leak ports was performed in both the epidural space and the subdural space, and the incarcerated brain hernia was cleared. Bone wax or bone cement was used to repair the skull defects. Fat patches were used to pack the leak port in the dura mater, and autologous fascia and artificial dura were used to repair the dural defects. Biological fibrin glue was used to strengthen the fixing material. Treatment for postoperative infection and supportive therapy were given to all the patients.Results Satisfactory results were achieved in all seven patients. One patient had a small amount of cerebrospinal fluid leakage about three weeks after the surgery, but was cured by conservative treatment. No recurrence of cerebrospinal fluid leakage was observed in the follow-up longer than 1 year.Conclusions Thin multislice head CT scan and parallel two-dimensional coronal reconstruction play significant roles in confirming the position of leak port. Surgical repairs in both the skull and the dura mater effectively patch the leak ports and produce satisfactory results.