Objective Typical y, the transcranial approach has been used for the treatment of craniopharyngiomas with suprasel ar extension, whereas the transsphenoidal approach has been used mostly for infradiaphrag-matic craniopharyngioma. Total resection of craniopharyngioma can reduce the recurrence rate, especial y in young children, but it may lead to severe complications. Therefore, any benefit of the degree of resec-tion must be weighed against the risk of complications by the surgeons. The purpose of this study was to explore the therapeutic outcome after transsphenoidal microsurgical treatment of infradiaphragmatic craniopharyngioma and share our experiences. Methods Between January 2003 and June 2013, 30 patients with infradiaphragmatic craniopharyngioma underwent transsphenoidal microsurgical resection in our hospital. The neurological, visual, and endocrine functions, and extent of resection were analyzed retrospectively. Recurrence or growth of residual tumor tissue during fol ow-up was assessed using magnetic resonance imaging (MRI). Results Total resection was achieved in 25 patients (83.3%), subtotal resection was achieved in 4 pa-tients (13.3%), and partial resection was achieved in 1 patient (3.4%). There were no perioperative deaths. Cerebrospinal fluid (CSF) leakage occurred in 6 patients, and among them, 2 required surgical repair of the sel a. New-onset postoperative diabetes insipidus (DI) developed in 8 patients. Vision and visual fields were improved at dif erent levels in 13 out of 16 patients who had sight impediments before treatment. Tumor recurrence and regrowth was observed in 2 patients; 1 patient underwent transsphenoidal reoperation, the condition of the other patient who had undergone several craniotomies grew worse over the 6-month fol ow-up period. Conclusion Transsphenoidal surgery is an ideal choice in treating infradiaphragmatic craniopharyngio-ma. The transsphenoidal approach, which preserves pituitary function and avoids damage to the hypotha-lamic structures and optic nerve, is associated with fewer complications than the transcranial approach and a low mortality rate.