<p>The extended endoscopic transtuberculum approach (EETA) for resecting purely supradiaphragmatic pediatric craniopharyngiomas lacks robust outcome data. This study evaluated the safety and efficacy of EETA in this population.&#xa0;A retrospective cohort study was conducted on consecutive pediatric patients who underwent EETA for purely supradiaphragmatic craniopharyngiomas (January 2018–July 2024) at a single institution. Outcomes included the extent of resection, complications, endocrine and visual function, adjuvant therapies, and recurrence.&#xa0;Among 14 patients (mean age 11.1 years, range 5–16), all presented with visual impairment, and 78.6% (<i>n</i> = 11) had preexisting hypopituitarism. The mean maximal tumor diameter was 3.6&#xa0;cm (range 2.7–5.1), with hypothalamic involvement in 35.7% (<i>n</i> = 5). Gross total resection (GTR) was achieved in 5 cases (35.7%), and near-total resection (NTR) was achieved in 5 patients (35.7%). Postoperatively, 57.1% (<i>n</i> = 8) experienced visual improvement, while 14.3% (<i>n</i> = 2) worsened. Complications included cerebrospinal fluid leak with meningitis (7.1%, <i>n</i> = 1). New anterior pituitary deficits occurred in 35.7% (<i>n</i> = 5) and permanent diabetes insipidus developed in 85.7% (<i>n</i> = 12). New-onset obesity was observed in 28.6% (<i>n</i> = 4). At the 12-month follow-up, no tumor recurrence or progression was observed; residual tumors in 7 patients were managed with stereotactic radiosurgery.&#xa0;In this small cohort, the EETA was a viable surgical option for purely supradiaphragmatic pediatric craniopharyngiomas, offering favorable resection rates and visual outcomes in experienced hands. However, it carried significant endocrine risks. These preliminary findings require validation in larger, prospective studies with long-term follow-up.</p>