Fibrous dysplasia is a benign bone disorder that most commonly affects craniofacial bones; one or multiple adjacent bones can be involved which can severely deform the skull base. Cerebrospinal fluid leakage in combination with extensive craniofacial fibrous dysplasia is an extremely rare condition that leads to complicated skull base deformation and possible neurovascular structure impingement. We described four cerebrospinal fluid leakage cases with extensive craniofacial fibrous dysplasia, highlighting the surgical complexity and individualized treatment strategy according to the different surgical indications. These cases exemplified the diverse repair options and demonstrated that individualized treatment strategy could achieve successful outcomes with minimizing complications.