Since there are many approaches for successful craniopharyngioma resection, how to choose a suitable approach remains problematic. The aim of this study was to summarize experience of approach selection and outcomes of craniopharyngioma resection in our institute. The data of 182 primary craniopharyngiomas between January 2013 and June 2019 were retrospectively reviewed. Craniopharyngiomas were classified into intrasellar, intra-suprasellar, suprasellar, and intra-third ventricle types based on the location. The surgical approaches, extent of resection, endocrine and ophthalmological outcomes, and complications were evaluated. Gross total resection (GTR) was achieved in 158 (86.8%) patients, near-total resection (NTR) in 20 (11%), and partial resection (PR) in 4 (2.2%). New-onset hypopituitarism occurred in 90 (49.5%) and new-onset diabetes insipidus in 48 (26.4%). Visual function was improved in 110 of the 182 patients, unchanged in 52, and deteriorated in 20. For intra-suprasellar and suprasellar tumors, patients in the endoscopic endonasal approach (EEA) group had higher GTR rate, lower incidence of new-onset hypopituitarism, and better visual outcome than patients in transcranial approach group, but no significant difference in the incidence of new-onset diabetes insipidus was found. There were no surgery-related deaths, and the common complications included permanent oculomotor nerve palsy, hemorrhage, and cerebrospinal fluid leaks. During the follow-up period, tumor recurrence or regrowth occurred in 6.6% of the cases. Tumor location is key for choosing an optimal surgical approach for craniopharyngioma resection. The EEA should be considered as the first choice for intra-suprasellar and suprasellar craniopharyngiomas to achieve better visual outcomes and fewer pituitary hormonal disorders.

由于成功的颅咽管瘤切除术有很多方法，因此如何选择合适的方法仍然存在问题。这项研究的目的是总结我院颅咽管瘤切除术的方法选择和结局的经验。回顾性分析了2013年1月至2019年6月间182例原发性颅咽管瘤的数据。根据位置将颅咽管瘤分为蝶鞍内，-上、,上和第三脑室内类型。评估手术方法，切除范围，内分泌和眼科预后以及并发症。158例（86.8％）患者实现了总全切除（GTR），近全切除（NTR）20例（11％），部分切除（PR）4例（2.2％）。新发性垂体机能减退发生在90岁（49。5％）和新发尿崩症48例（26.4％）。182例患者中的110例的视觉功能得到改善，52例中的52例保持不变，20例中的视力下降。对于上up内和鞍上肿瘤，内镜鼻腔内入路（EEA）组患者的GTR率较高，新发垂体功能减退的发生率较低比经颅入路治疗组的患者视觉效果更好，但新发尿崩症的发生率无明显差异。没有手术相关的死亡，常见的并发症包括永久性动眼神经麻痹，出血和脑脊液漏。在随访期间，6.6％的病例发生了肿瘤复发或再生长。肿瘤的位置是选择颅咽管瘤切除术最佳手术方法的关键。