Аннотация:The incidence of craniopharyngioma is 0.5–2.5 cases per 1 million, that is, 2–5% of all primary brain tumors in adults [1] and 5.6–13% in children [2]. Most often craniopharyngiomas appear in the age groups of 5–14 years and 50–74 years [3]. These tumors form the largest group of non- glial tumors in children. CP contribute to up to 56% all tumors of the chiasmo-sellar region in children [2]. In 2011, Nielsen et al. performed a meta-analysis of 15 epidemiological studies of CP (with total of 1232 patients). According to these data, the incidence was 1.34 (1.24–1.46) per 1 million people and 1.44 (1.33–1.56) per 1 million children [4]. Taking into account the benign nature of craniopharyngiomas, the main method of treatment is the removal of the tumor. However, the tendency of these tumors to invade critical structures (such as optic pathways, the hypothalamic- pituitary system, the Willis circle vessels) often limits the possibility of a radical surgery [5, 6]. Craniopharyngiomas of the third ventricle represent the greatest challenge for surgery [7, 8]. After radical operations, hypothalamic disorders often occur, including not only obesity but also cognitive, emotional, mental, and metabolic disturbances. Metabolic disorders associated with damage to the hypothalamus progress after surgery and lead to impaired functions of the internal organs. This process is irreversible and, in many cases, becomes the direct cause of the patient’s death. The life expectancy of patients with the surgically affected hypothalamus is significantly shorter than without them. The incidence of hypothalamic disorders after surgery can reach 40% [9]. Even with macroscopically total resection, craniopharyngiomas can recur in 10–30% of cases [10–13], and in the presence of tumor remnants and with no further radiation treatment, the risk of recurrence significantly increases [7, 13, 14] to up to 50–70% according to various studies [15, 16] and even up to 85% [11, 17, 18]. For this reason, the observation of patients with residual tumors after surgery is an incorrect strategy. Radiation therapy significantly improves progression free survival (PFS), and the use of stereotactic irradiation techniques ensures conformity of irradiation of tumor remnants with a complicated shape and location [19–22], which potentially reduces the risk of undesirable post- radiation effects. Therefore, the quality of life in patients with craniopharyngiomas infiltrating the anterior third ventricle is significantly higher after non-radical operations with subsequent stereotactic radiation than after a total or subtotal removal [22, 23].