Endoscopic repair of cerebrospinal fluid (CSF) leaks and meningoencephaloceles is largely successful, with rates of skull-base defect closure greater than 90%. • Certain factors may increase the potential for recurrence of CSF leak or meningoencephalocele. Identification of such factors in the preoperative period allows the surgeon to alter treatment protocols accordingly. • Diagnosis of recurrent CSF leaks and meningoencephaloceles often incorporates preoperative and intraoperative techniques. A combination of laboratory testing, radiologic imaging, and special procedures may be required to accurately diagnose the site of a skull-base defect. • Surgical techniques for endoscopic repair of recurrent CSF leaks and meningoencephaloceles vary by the site and size of the skull-base defect, as well as surgeon experience. Certain types of recurrent CSF leaks and meningoencephaloceles may require additional perioperative measures for increased repair success.