OBJECTIVE: To study the better method of surgical management of craniopharygioma. METHODS: We treated 30 patients with craniopharyngioma ranged in age from 15 to 55 years (mean: 34.13 years old). MR image showed that the tumors' diameter varied from 2.0 cm to 6.0 cm (mean, 3.34 cm). 17 patients had the tumor in suprasellar region, 11 had tumor extension in the third ventricle 2 and had the tumor down to insellar. Complete cystic tumor was seen in 5 patients, partial cystic tumor in 17, and solid tumor in 8. Calcified tumor was found in 18 patients. Frontal temporal craniotomy was performed in all patients. The tumor was dissected in the parachiasmal opticocarotid, carotidotentorial spaces and lamina terminals. Great attention was paid to the preservation of the perforating arteries from the carotid, posterior and anterior communication and anterior choroidal arteries to the structure of the hypothalamus. The solid portion of the tumor was removed by piecemeal. RESULTS: The tumor was totally removed in 29 patients and subtotally removed in 1 patient by second surgery. Follow-up showed that 27 patients resat normal life, 1 patient needed assistance, 1 died 7 days after surgery from inhalation asphyxia, and 1 died from complications of diabetes insipidus. CONCLUSIONS: Many different surgical approaches can be used in the treatment of carniopharyngioma according to the localization and extension of the tumor. However, avoidance of the neural structures injury in the third ventricle and preservation of the perforating arteries to hypothalamus are essential to achieving a good surgical result.