Management of patients with sphenoidal cerebrospinal fluid rhinorrhea remains controversial. With consideration of the etiology of cerebrospinal fluid leaks, size of the sinus, location of the fistula, and previous surgery, one may choose either an extracranial or transcranial approach. In two patients in whom conventional procedures failed or seemed to be inapplicable, the cerebrospinal fluid leak was successfully treated through an original transfacial approach with palpebral incisions. A transzygomatic osteoplastic flap provided access to close the fistula and to exclude the sinus with a bone graft.