Craniopharyngioma in children is the most common intracranial congenital tumor in children. It is known that the incidence of craniopharyngioma in our population accounts for 4.7-6.5% of all intracranial tumors. Among them, 70% are children under 15 years old. Since the first symptom of craniopharyngioma in children is vision loss, it is very easy to be misdiagnosed, so parents must not take it lightly. Craniopharyngioma is a benign congenital tumor, but its growth often involves important structures in the hypothalamus, so it needs to be completely removed to avoid affecting the patient’s growth and development. Unfortunately, due to the lack of knowledge of the parents or some non-specialized medical personnel, the children are too late for diagnosis or cannot receive effective treatment. If when the child’s vision is severely impaired, even if the tumor is removed by craniotomy, the damage to vision cannot be fully recovered, or even blindness. Alert to five signals Signal 1: visual field change It is not uncommon to see visual field disorder as the first symptom, which accounts for about 60%~80% of craniopharyngiomas. Due to the different compression sites of the tumor on the visual pathway, different visual field defects are clinically manifested. Due to the compression of the optic cross, bilateral temporal (lateral) hemianopsia occurs, compression of the optic bundle (the section between the optic cross and the lateral geniculate body) on one side may produce isotropic hemianopsia (i.e., lateral hemianopsia of one eye and medial hemianopsia of the other eye), and compression of the optic nerve on one side may result in monocular loss of visual acuity or blindness. It is often difficult to measure changes in the visual field because children are sometimes unable to describe the visual field or are uncooperative during examination. Signal 2: Increased intracranial pressure, which is mostly seen in children with craniopharyngioma, can be the first symptom, which is mainly due to the tumor obstructing the ventricular system causing hydrocephalus and elevated brain pressure. Clinically, it manifests as headache, nausea and vomiting, optic nerve papilla edema, diplopia and neck pain. In infants and some pediatric patients, there may be cracking of cranial suture, enlargement of skull, and “broken pot” sound when knocking. Signal 3: endocrine disorders: 2/3 of craniopharyngioma patients have endocrine disorders, such as polydipsia, delayed growth and short stature. In the case of male adolescents, sex organs may not develop and secondary sexual characteristics may be lacking. Signal 4: Changes in consciousness Some of the affected children have impaired consciousness, which is manifested as indifference or drowsiness, and a few of them may be comatose. This may be due to the damage of the lower thalamus and the pressure on the midbrain due to brain herniation. Signal 5: change of optic nerve papilla Due to the increase of intracranial pressure, the children will have edema of optic nerve papilla, which will cause optic nerve atrophy, vision loss and even blindness. If the tumor directly compresses the optic nerve, primary optic atrophy will occur.