This article discusses the rare occurrence of CSF fistulas of the lateral recess of the sphenoid sinus, which account for 7.7% of all skull base leaks. It presents three clinical cases of spontaneous cerebrospinal fluid leaks from this area and the surgical treatments used, including transsphenoidal and transpterygoid endoscopic approaches. The postoperative results varied, but the study found that the success of the plastic surgery did not depend on the type of endonasal surgical approach used. Instead, it was influenced by the quality of the plastic and the preoperative level of CSF pressure. This contributes to the literature by providing insights into the factors influencing the success of surgical treatment for this rare condition.