Background: Endoscopic endonasal transsphenoidal pituitary surgery (EETPS) is widely adopted for the management of pituitary adenomas and sellar lesions; however, postoperative cerebrospinal fluid (CSF) rhinorrhea remains a major source of morbidity. Objective: This study aimed to evaluate the clinical outcomes of endoscopic sellar reconstruction after transsphenoidal pituitary surgery from an otolaryngologic perspective, with particular emphasis on the effectiveness of a standardized, graded reconstruction algorithm in minimizing postoperative CSF rhinorrhea and associated complications. Methods: This hospital-based observational cross-sectional study was conducted at Imam Ali Hospital and Al-Kindy Teaching Hospital, Baghdad, Iraq, between March 2024 and May 2025. A total of 195 consecutive adult patients undergoing EETPS for pituitary adenomas or other sellar lesions were included. All procedures were performed using a collaborative neurosurgical-otolaryngologic endoscopic approach. Sellar reconstruction was carried out according to a standardized, graded algorithm based on intraoperative CSF leak status and defect size. Demographic data, tumor characteristics, intraoperative findings, reconstruction techniques and postoperative outcomes were analyzed. The primary outcome was postoperative CSF rhinorrhea, while secondary outcomes included postoperative complications and factors associated with CSF leakage. Results: Intraoperative CSF leakage was observed in 74 patients (37.95%), including high-flow leaks in 21 patients (10.77%). Multilayer reconstruction was employed in 148 cases (75.90%), with nasoseptal flap utilization in 62 patients (31.79%). Postoperative CSF rhinorrhea occurred in 12 patients (6.15%) and was significantly associated with high-flow intraoperative CSF leakage (28.57%, p = 0.001), macroadenoma size (p = 0.009) and absence of vascularized flap reconstruction (p = 0.003). Other postoperative complications were infrequent and generally mild. Conclusion: A standardized, graded sellar reconstruction algorithm in EETPS is effective in reducing postoperative CSF rhinorrhea, particularly when reconstruction strategies are escalated in cases of high-flow intraoperative CSF leakage. From an otolaryngologic perspective, the integration of vascularized flaps and tailored reconstruction plays a crucial role in improving surgical outcomes and minimizing CSF-related complications.