This paper reports two cases of craniopharyngioma in the elderly (over 70 years old). The first case is a 74-year-old woman who was referred to us due to gait and visual disturbance. She was first treated conservatively because she showed signs of dementia, but her tumor grew remarkably and rapidly after placement of a ventriculoperitoneal shunt and then was partially resected. After two shunt revisions, the patient developed postoperative pneumonia, which became the main cause of her death. The second case was a 79-year-old female who was referred to us due to progressive visual disturbance. She was operated on and her tumor was totally resected. A bilateral subduroperitoneal shunt was placed to alleviate postoperative subdural effusion. Postoperatively, her visual field improved remarkably. When treating craniopharyngioma in the elderly, it is advisable to choose a conservative approach if applicable. When a more radical therapeutic approach is taken, it should be borne in mind that preexisting dementia and postoperative subdural effusion due to brain atrophy often preclude the patient's early recovery.