Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence