Objective: This study summarizes the clinical characteristics and treatment regimens of different types of cerebrospinal fluid rhinorrhea (CSFR), with a focus on exploring the application value of the free middle turbinate mucosal flap in CSFR repair. Methods: A retrospective analysis was performed on the clinical data of 66 CSFR patients admitted to the Department of Otorhinolaryngology-Head and Neck Surgery, Changsha Central Hospital Affiliated to University of South China, from September 2021 to January 2025. The etiologies mainly included four categories: traumatic, iatrogenic, spontaneous, and tumor-induced. Different treatment methods were adopted, and regular postoperative follow-up was conducted to evaluate the surgical efficacy and complications. Results: The most common sites of skull base defects were the cribriform plate (18 cases, 27.3%), the cribral roof (14 cases, 21.2%), and the lateral recess of the sphenoid sinus (12 cases, 18.2%). Patients with spontaneous cerebrospinal fluid rhinorrhea had significantly higher BMI, triglyceride levels, female proportion, and hypertension prevalence compared with those with non-spontaneous cerebrospinal fluid rhinorrhea (P＜0.05). A total of 51 patients underwent surgical repair, and individualized skull base reconstruction techniques were adopted according to the location and size of the fistula. All reconstructions achieved successful outcomes, with no recurrence during a postoperative follow-up of at least 6 months. Among these patients, 31 cases (60.8%) underwent repair using the free middle turbinate mucosal flap. Conclusion: Endoscopic repair with free middle turbinate mucosal flap combined with autologous fascia is a safe and effective surgical method for the treatment of cerebrospinal fluid rhinorrhea, which makes up for the deficiencies of traditional surgical procedures such as limited material selection and great trauma. It is suggested that clinical treatment plans should be formulated in combination with the characteristics of fistula locations and individual patient differences, and the minimally invasive value of this surgical method should be maximized through standardized diagnosis and treatment processes, thus providing a new clinical approach for the precise repair of cerebrospinal fluid rhinorrhea.