A 42 year old man presented with a history of recurrent watery rhinorrhea and a salty taste in his mouth. He was previously diagnosed with a traumatic CSF leak and underwent a trans-nasal trans-sphenoidal repair under the care of the neurosurgeons. He had a history of hydrocephalus, learning difficulties and a previous ventriculo-peritonea (VP)l shunt. A CT Cisternogram demonstrated a defect and leak in the left sphenoid sinus. A new venticulo-peritoneal shunt was inserted after removal of the old one, followed by a trans-nasal endoscopic repair of the defect in the sphenoid using a fat graft.