Background: The expanded endonasal approaches to the skull base are modular approaches that arise from the sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications. Available flaps for reconstruction include the pedicled nasoseptal flap, the trans- pterygoid temporoparietal fascia flap, and the posterior pedicle inferior turbinate flap (PPITF), among others. Recently, the middle turbinate flap and nasoseptal flap have been described in a cadaveric study. Objective: The aim of the current study was to compare results of using nasoseptal versus middle turbinate flaps in skull base reconstruction. Patients and methods: This interventional cohort study was carried out on 24 patients in Department of Otorhinolaryngology, Head and Neck Surgery, Zagazig University Hospitals. All patients with CSF leaks of variable reasons (congenital, traumatic, spontaneous) who required surgical repair with either vascularized nasoseptal mucosal flap or vascularized middle turbinate mucosal flap and fit for general anesthesia were included in the study. Results: Incidence rate of operation failure that was temporary (8.3%) in NSF group while in MTF the success rate was 100%. Conclusions: There are no significant differences in results of using nasoseptal versus middle turbinate flaps in skull base reconstruction.