Forty-three children with craniopharyngiomas were operated upon at The Neurological Institute of New York between 1952 and 1977. The removal was thought to be total in 14 children and subtotal in 20, and cyst aspiration/biopsy was performed in 9 cases. Radiation was given as part of the initial therapy in 6 children after subtotal removal and to 8 others after aspiration/biopsy. There was 1 postoperative death. All children with tumors thought to have been removed totally are alive. The 10-year actuarial survival rates are 52% for subtotal removal alone and 87% for subtotal removal plus radiation. Tumors have recurred by 10 years in half of those thought to be totally removed, in more than 90% of those subtotally removed, and in less than 25% of those at risk after subtotal removal and radiation therapy. Tumors recurred in 22 children, and 17 underwent reoperation. Total removal was obtained in 4 cases, and 5 had radiation after subtotal removal. Radiotherapy alone was used in 2 cases. Recurrences usually occurred within 2 years. However, after "total" removal recurrences were quite delayed. Our data indicate that total removal allows excellent survival rates and that some of these children are potentially cured. The attempt at total removal did not inflict a severe hypothalamic or visual burden on these children. Where total removal is not possible, further therapy, either radiation or reoperation, will be required. Radiation dramatically decreased recurrence and improved survival after subtotal removal.