Objectives: To describe the evolution and outcomes of our graded skull base repair protocol in endoscopic pituitary surgery. Methods: Retrospective cohort study of 406 consecutive patients who underwent endoscopic pituitary surgery for adenoma at our institution. The repair protocol underwent two modifications across three study periods. From 2013 to 2016, protocol was based solely on the grade of intraoperative cerebrospinal fluid (CSF) leaks. Between 2017 and 2019, sellar diaphragm descent was incorporated. Since 2020, preoperative risk factors such as obesity, previous surgeries, and prior irradiation were included, influencing the materials used in skull base repair. Results: Postoperative CSF leak rate decreased across study periods; 12.5% (14/112), 6.2% (7/113) and 2.2% (4/181), respectively. This difference was statistically significant between the first and last period. Overall, CSF leak incidence was 6.2% (25/406), CNS infection 0.7% (3/406) and mortality rate 0.2% (1/406). Among study periods, intrasellar fat graft utilization increased from 44.6% (50/112), 77.9% (88/113) and 84.0% (152/181). Vascularized flaps were employed in 20.5% (23/112), 52.2% (59/113), and 47.5% (86/181). Nasoseptal flap was the predominant choice. Dural substitute use decreased progressively: 81.2% (82/112), 55.4% (51/113), and 7.2% (13/181). Conclusions: The learning curve and refinement of our graded skull base repair protocol resulted in a substantial reduction in postoperative CSF leak rate. The presence and magnitude of intraoperative CSF leaks, diaphragm descent, and preoperative risk factors for postoperative CSF leaks were essential for guiding skull base reconstruction following pituitary surgery.