The aim of the research was to study changes in clinical and neuropsychological deficits in children with neoplasms of the chiasmal-sellar region (CSR) operated on via transcranial and endoscopic transsphenoidal approaches. The analysis of clinical and neuropsychological examination and surgical treatment of 24 children with CSR tumors was carried out. Two leading neuropsychological symptom complexes in children with CSR neoplasms were identified. Changes in neuropsychological parameters in children with CSR neoplasms during the studied observation period do not directly depend on the volume of the tumor. In the early postoperative period, timely correction of the identified fluid and electrolyte disorders is necessary for better recovery of the patient’s neuropsychological deficit. The preservation of cognitive functions in children after the removal of a CSR neoplasm is influenced not so much by the volume of the tumor or surgical access, as by the gentle technique of the operation.