OBJECTIVE: To understand the pathological changes of pediatric craniopharyngiomas so as to analyze its diagnosis, operative strategy and to prevent the damage of hypothalamus. METHODS: 189 cases of pediatric craniopharyngiomas treated from 1990 to 1998 were reviewed and analyzed via their CT, MRI, and surgery. RESULTS: 187 cases (98.9%) were cystic tumors, including 176 with calcification (93.1%); two cases were solid tumors (1.1%), and calcification occurred in only one. A gliosis layer between the wall of tumor and the hypothalamus was seen. CONCLUSION: Cystic change and calcification are the pathological features of pediatric craniopharyngiomas. There are some special relations between the tumors and stalk. These are the bases for total removal of pediatric craniopharyngiomas.