Craniopharyngioma are among the most challenging tumors to manage in children. The tumor’s proximity to critical neural structures poses significant management challenges, as these structures are still developing and highly sensitive to intervention. We reported a case of giant craniopharyngioma in a 3-year-old boy, which was managed successfully with complete excision, and the patient recovered well. 

The boy was admitted with a history of chronic headache and vomiting that had persisted for one month. His social, language, and cognitive developments were normal with no overt neurological deficits. Contrast-enhanced Magnetic Resonance Imaging (MRI) revealed a complex multiloculated cystic mass, measuring 52 × 53 × 51 mm and occupying sellar and suprasellar regions, with heterogeneous enhancement. The tumor compressed the hypothalamus anterosuperiorly, displaced the optic chiasm, and stretched the bilateral optic tracts. He underwent a pterional craniotomy with near-total tumor resection, removing the lesion within its capsule.

Postoperatively, the child developed diabetes insipidus, a known complication in craniopharyngioma surgery, which was managed medically. He otherwise had an uneventful recovery, with no new neurological deficits observed.