To investigate the causes and treatment of severe postoperative central diabetes insipidus (CDI) in patients after surgery for intrasellar-suprasellar craniopharyngioma. Methods: Clinical data were collected of 36 patients treated in our hospital who developed severe CDI after surgery for intrasellar-suprasellar craniopharyngioma. The positional relationship between tumor and three ventricles, tumor texture and whether or not the tumor adheres to surrounding tissues were the main factors to be analyzed. The relationships between the main three key factors and the occurrence of CDI were investigated. The therapeutic experience was summarized. Results: The incidence of postoperative CDI was higher in cases of intraventricular intrasellar-suprasellar craniopharyngioma than in cases of the extraventricular form (P<0.05). Tumors displaying adherence to surrounding tissues showed a higher incidence of postoperative CDI compared to tumors without adherence (P<0.05). Hardness of the tumor showed no significant effect on the incidence of postoperative CDI (P>0.05). After active treatment, 34 cases (94.44%) were controlled in the short term; the control time period was (9.47±5.87) days. Two patients (5.56%) required long-term drug control for diabetes insipidus. Conclusion: Patients with intraventricular intrasellar-suprasellar craniopharyngioma adhering to surrounding tissues are more likely to develop severe CDI after operation; there is no significant correlation between tumor texture and the incidence of postoperative CDI. The majority of severe postoperative CDI cases can be effectively controlled by active treatment.