Abstract： Objective A review of surgical outcome of 309 craniopharyngioma cases.Method We reposed 309 cases of craniopharyngiomas that were treated surgically from January 1996 to August 2006.162 (52.4%)patients were male and 147(47.6%)female.259(83.8%)patients were older than 15 years (mean age,35.8 years),and 50 patients(16.2%)was younger than 15 years(mean age,8.8 year).The tumor size varied in diameter from 2.0 cm to 9.0 cm(mean diameter,34.5mm).Tumors were classified into superior ventricular type and the inferior ventricular type based on their location relative to the floor of the third ventricle.For the inferior ventricular type,pterional approach was performed in 209 (67.6%)cases,the laminal terminal through frontobasal interhemispheric approach in 55(1 7.8%)cases,and subfrontal approach in 20(6.5%)cases were used.For the superior ventficular type,the laminal terminal approach in 14(4.5%)cases and the transcallosum approach into the anterior third ventricle was performed in 11(3.6%)cases.Results Total,subtotal and partial removal of the tumors were achieved in 276(89.3%),20(6.5%),and 13(4.2%)patients,respectively.The pituitary stalk was preserved in 186(60.2%)cases,severed in 49(15.9%)cases,and unidentified in 74(23.9%)cases during surgery.12(3.9%)patients died within one month after the surgery.204(66%)patients were followed from 6 months to 8 years(mean,2.1 Yrs.).In five deaths,four deaths occurred from secondary to hypopituitarism and hypothalamic deficiency,while one patient with other causes.Conclusions Using the floor of the third ventricle as the landmark through pre-surgery neuroimaging evaluations,we propose to classify craniopharyngiomas into two types:the superior ventricular type and the inferior ventricular type.It provided a better means to choose the approach that allowed us to protect the hypothalamic structures and its perforating arteries.We have shown lower mortality,morbidity and recurrence rate in total resection of craniopharyngioma compared to subtotal and partial resection.In addition,we would like to emphasize the importance of preservation of the pituitary stalk when total resection the tumor is feasible.