Abstract: Objective: To investigate the surgical approaches for treating craniopharyngiomas, the factors influencing total resection and the prevention of complications. Methods: From January 1995 to January 2005, 46 cases with craniopharyngioma underwent microsurgery. Major clinical manifestations included headache, vision and visual field disorders, hypothalamic dysfunctions and diabetes insipidus. Various approaches were used to remove the lesions, including the pterional approach in 20 cases (43.5%), the subfrontal approach in 12 cases (26.1%), the transcallosum interfornix approach in 3 cases (6.5%), the transfrontal longitudinal fission approach in 5 cases (10.9%), and the frontal corticaltransventricular lateral cerebral-ventricle interventricular-foramen approach in 2 cases (4.3%). Results: Total or subtotal resection was performed in 31 cases (67.4%), and partial removal was performed in 15 cases (32.6%). Perioperative death with incidental hypothalamic injury occurred in 1 case (2.2%). Major postoperative complications included diabetes insipidus, blood electrolyte disorder and epilepsy. Conclusions: The correct selection of the operative route, skillful microneurosurgical technique and intraoperative protection of the hypothalamus and its basilic perforating-branch blood vessels, as well as the active postoperative prevention of complications are all key factors influencing the prognosis of craniopharyngioma.