Craniopharyngioma is a benign tumor occurring in the suprasellar region of the skull involving the hypothalamus, and complete cure can be achieved after surgical excision. However, because the tumors mostly erode the hypothalamic structures such as pituitary stalk, funnel, gray nodes, papillary bodies and optic cross, it is difficult to remove the tumors surgically, and postoperative hypothalamic damage comorbidities such as uveitis, hyperthermia and coma seriously affect the patient’s healing. The incidence of craniopharyngioma in North America is about 0.13/100,000 of the population; it accounts for 2.7%-4.9% of the incidence of intracranial tumors in Europe; domestic reports account for 3.5-5% of the incidence of intracranial tumors, including 5% in children and 3.5% in adults. The common treatment methods include external radiotherapy, intra-stromal radiotherapy and chemotherapy, and surgical resection. Due to benign growth of tumor, it can be accompanied by cystic change and calcification, which is insensitive to radiotherapy and chemotherapy, and cannot well relieve the compression of hypothalamic nerve structures, and also has the risk of causing radiological damage, such as aggravation of visual impairment, polyuria in early stage, hypothalamic hypofunction and mental retardation in late stage. Due to the high mortality rate and serious comorbidities, partial resection of the tumor combined with external radiotherapy has been used to slow down the development of the disease. 1990 craniopharyngioma is a benign tumor occurring in the suprasellar region of the skull involving the hypothalamus, and complete cure can be achieved after surgical resection. However, because the tumors mostly erode hypothalamic structures such as pituitary stalk, funnel, gray nodes, papillary body and optic cross, which makes surgical removal of tumors difficult and postoperative hypothalamic damage comorbidities such as uveitis, hyperthermia and coma seriously affect the patient’s healing, the effectiveness of treatment for craniopharyngioma is one of the marks of neurosurgical level. The incidence of craniopharyngioma in North America was reported around the year, Yasargil, Switzerland firstly reported that the surgical total resection rate of tumor was 90% and the postoperative mortality rate was 16%; in 1992, Hoffman et al. reported that the surgical total resection rate of tumor was 60% and the postoperative mortality rate was 20%; and suggested that the efficacy was closely related to the surgical method, tumor resection rate, and the protection of hypothalamic nerve structure during surgery. Since then, people began to explore the positive total tumor resection for the following reasons: 1, total resection can achieve the effect of complete cure; 2, partial resection of tumor has no definite efficacy and can cause disorder of anatomical structure of the operated area and adhesion of tumor with surrounding structures, which makes secondary surgery difficult and more difficult to make total resection of tumor; 3, there is no other good treatment method for most tumors. From the literature, the postoperative mortality rate of total tumor resection decreased from 20% before 1990 to less than 10% in 1995, and to less than 5% in 2000. The preservation of hypothalamic nerve structure and function is the key; the anterior hypothalamic structures of the three ventricles are divided into five parts; the craniopharyngioma is classified into subhypothalamic and suprahypothalamic types according to the site of occurrence. For subhypothalamic tumors, the anterior longitudinal approach is mostly adopted. For the latter, the pterygoid, inferior frontal and transsphenoidal approaches are mostly adopted to remove the tumor using the neurovascular gap, which can reveal the tumor from multiple directions, but the intraoperative manipulation increases the risk of vascular nerve injury and vasospasm. In addition, surgical protection of the microscopic penetrating arteries of the hypothalamus is important to preserve the function of the hypothalamus and to prevent postoperative complications such as memory impairment, uveitis, hyperthermia, coma and paralysis. Total tumor resection is defined as, surgical microscopic removal of the entire tumor with postoperative imaging confirming the disappearance of the tumor. At present, the reasons that make total resection of tumor difficult are: 1) large calcified tumor; 2) adhesion of tumor to hypothalamic structures or penetrating arteries; 3) thin wall of tumor capsule that cannot be separated from surrounding structures; 4) restriction of surgical field of view to see residual tumor, and postoperative imaging reveals that tumor is not fully resected. In patients who were followed up within 10 years after surgery, there was still 10% tumor recurrence rate. The main reasons for this are: 1) tumor cells may remain after total resection; 2) tumor cells are displaced and grow during surgery; 3) tumor is not separated from the third ventricular floor by the arachnoid membrane and grows invasively in the hypothalamus. For patients with recurrent tumor with occupational effect, secondary surgery can be performed to remove the tumor. For recurrent solid tumors away from neural structures, r-knife or other stereotactic radiotherapy can be used. Postoperative hypothalamic and pituitary dysfunction complications can occur after total resection in about 50% to 80% of patients. Early surgical pituitary complications include uremia caused by antidiuretic hormone deficiency, in which patients mainly exhibit thirst, polyhydramnios and polyuria; abnormal antidiuretic hormone secretion syndrome, in which patients have polyhydramnios and polyuria in addition to hyponatremia, characterized by hyponatremia, which in severe cases causes cerebral edema, and patients have headache, nausea, vomiting and convulsions, i.e. cerebral salt depletion syndrome. There is also damage to the supraoptic pituitary bundle, supraoptic nucleus and paraventricular nucleus, and the patient has dysfunctional water foraging and no thirst. Elevated blood sodium, generalized weakness and mild uremia, also known as cerebral salt retention syndrome. Anterior pituitary hormone deficiency is a complication that requires long-term treatment after craniopharyngioma resection, including growth hormone replacement therapy for children with developmental dystrophy and retardation; gonadotropin replacement therapy for patients with sexual developmental disorders due to androgen and estrogen deficiency, and glucocorticoid replacement therapy for hypothalamic hypofunction and thyroxine replacement therapy for hypothyroidism. Although there are various synthetic hormone replacement treatments for hypothalamus and pituitary hormones, the function of hypothalamus and pituitary hormones is not merely to give hormone replacement methods alone. Rather, it is a systematic and comprehensive physiological and clinical treatment. From our postoperative follow-up data, patients with prepubertal development, where hypothalamic function is not severely involved, and where the hypothalamus is well protected after total tumor resection, patients can still resume physical growth and sexual function development.