Because of its close relationship with important surrounding tissue structures, craniopharyngioma itself and its treatment can lead to serious long-term complications. For many years, the most appropriate treatment for them has been controversial. This study reviews the treatment of craniopharyngioma in children at our institution over the last decade and discusses the treatment trends over the last 30 years (1975~1989, 1990~2001, 2001~2011). Results: 1. Patient characteristics: 33 pediatric patients (15 females) with a mean age of 10.7 years and a follow-up age of 4 years (0.7 to 9.3). 2. Clinical manifestations: headache in 28 cases (85%), visual impairment in 25 cases (76%), nausea and vomiting in 14 cases (42%), obesity in 7 cases (21%), and underweight in 5 cases (15%). In pituitary dysfunction mainly GH, ACTH and TSH abnormalities with diabetes mellitus were observed. The mean diameter of the tumors was 4.9 cm (2.2-12,6), and most of them had cystic degeneration and calcification. 3. Treatment 1. Preferred treatment: 18 cases were treated with cyst decompression, and adjuvant treatment was radiotherapy or intracapsular chemotherapy. Due to the neurotoxicity of bleomycin, by 2005, we stopped intracapsular chemotherapy with this drug and replaced it with intracapsular injection of alpha-interferon. Radiotherapy and other treatments were done with 5400 CGy, in 30 fractions. Radiotherapy was avoided as much as possible until the age of 10 years. Fourteen patients (42%) received radiotherapy and 8 (24%) received intracapsular chemotherapy (4 bleomycin and 4 gamma-interferon). 3 cases were treated with gamma-interferon chemotherapy from the beginning stage and 2 cases were recurrence-free at 20 and 28 months of follow-up, and the third case was followed up at 41 months without further treatment after 2 months of treatment by re-evacuating the capsule fluid. The fourth case was a recurrence case with short follow-up time. 2. long-term treatment effect 1 7 patients had tumor recurrence (52%), and the mean time of recurrence was 11.5 M; 4 of them were considered total resection patients, and 2 needed a second operation. 7 patients with preferred radiotherapy, 2 had recurrence, 1 had cyst fluid drainage, and the other had partial resection of tumor. 4 of 7 patients with intracapsular chemotherapy had recurrence, 3 had cyst fluid drainage, and 1 had partial resection by surgery. We found that the younger patients were prone to recurrence. Only one patient died due to acute infection. The survival rate was 97%. 29 patients had at least one pituitary hormone deficiency, the most common being GH in 28 (85%), of which 8 were present before treatment. 24 (73%) had TSH deficiency, 21 (64%) had ACTH deficiency, 20 (61%) had LH and FSH deficiency, and 18 (55%) had ADH deficiency. At follow-up, 19 cases were obese (7 of them were obese at presentation) 3. Treatment trends and outcomes from 1975 to 2011 In the last decade, there has been a significant decrease in cases of craniopharyngioma GTR and a significant increase in cases of microinvasive partial resection. From 1975 to 1989, maximum resection of the tumor was performed with a view to obtaining a cure. For recurrent tumors a combination of reoperation or radiotherapy was used. from 1990 to 2001, there was a shift to conservative treatment with partial resection of the tumor, supplemented by radiotherapy if necessary, and the emergence of intratumoral chemotherapy. From 0 cases before 1990, 1 case from 1990 to 2001, to 8 cases in the last decade. Cases of patients with preferred radiotherapy are also increasing, from 0 cases in 1975 to 2001 to 7 cases (21%) in the past decade. Adjuvant therapy has gone from 0 to 2% and 42% now. The recurrence rate of tumors has not changed significantly in the last 30 years. 34%, 30% to 52%, diabetes and corticosteroid function in the first and second time were 69%, 89% and 79%, 93% respectively. 49% and 64%, respectively, in the last decade. The incidence of obesity has also decreased. Thus, with the shift of craniopharyngioma treatment from total resection to comprehensive treatment, the endocrine damage of patients has improved, on the one hand to achieve the purpose of prolonging patients’ lives, but also to help improve their quality of life, and the recurrence rate of tumors has not changed much.