The objective of the present study was to develop a rationale for the approach to be employed in endoscopic surgery of nasal liquorrhea. A total of 69 patients presenting with this condition were available for the observation. Traumatic liquorrhea accounted for 80% of the cases, iatrogenic liquorrhea for 10%, liquorrhea associated with malformations for 5%, and spontaneous liquorrhea for 5% of the cases. The diagnostic algorithms elaborated for the identification of liquor cartilages were used to develop the criteria for the choice of the operative approach. A total of 69 surgical interventions were performed including 54 transnasal, 20 transethmoidal, 29 transsphenoidal, 5 endonasal, and 15 transcranial operations. The liquor fistulas were closed using tissue fragments and artificial materials, viz. muscles, broad fascia of thigh, periosteum and cartilage of the nasal septum, the mucous membrane from the nasal cavity, TachoComb plates, hemostatic sponge, fibrin-thrombin glue, bone crumbs, elements of bone marrow, and stem cells. The study has demonstrated the advantages of transnasal surgical treatment of liquor fistulas. The principles of postoperative care for the patients have been developed.