Spontaneous cerebrospinal fluid (CSF) fistula is an important clinical entity that can be related to anatomical defects in the lateral or anterior skull base in conjunction with excess production or inadequate resorption of CSF. The recurrence rates for spontaneous leaks are higher than other etiologies and may be related to underlying elevated intracranial pressure. Spontaneous CSF leaks generally present with otorrhea or rhinorrhea depending on the site of leakage in the anterior, middle, or posterior cranial fossa. Successful management requires accurate diagnosis and targeted surgical repair to minimize the risk of associated symptoms, including infectious intracranial complications. This panel is comprised of otologists/neurotologists and rhinologists and endorsed by the Otology Neurotology Education Committee and Skull Base Surgery Committee. The presentation will comprehensively review the diagnostic and treatment algorithm for management of spontaneous CSF otorrhea and rhinorrhea. Salient pathophysiologic mechanisms will be discussed. The role of imaging studies, including computed tomography, magnetic resonance imaging, and radionuclide studies, will be outlined. Open and endoscopic techniques for repair of anterior (rhinologic) and lateral (otologic) skull base CSF leaks will be reviewed. The utility of various graft materials used in repair and the role of perioperative lumbar drainage will be explored. Long-term management strategies for increased intracranial pressure, including the use of diuretics and CSF shunting, will also be discussed. Postoperative evaluation and identification of idiopathic intracranial hypertension is essential to prevent long-term complications such as recurrent fistulas and vision loss. A multidisciplinary approach with close collaboration between neurosurgery, neurology, and ophthalmology will be stressed. A case-based format will be utilized to illustrate key clinical points.