Background: Craniopharyngiomas are rare Sellar and suprasellar tumors that can cause significant visual, endocrine, and hypothalamic morbidity. Treatment decisions in older adults are complicated by higher comorbidity burden, reduced physiological reserve, and limited data especially for the very elderly. Because most studies group all patients ≥65 together, the survival impact of surgery and radiotherapy in elderly subgroups remains unclear. Methods: A retrospective cohort study was conducted using SEER 17 (2000–2022). Patients aged ≥50 years with histologically confirmed craniopharyngioma were categorized as non-elderly (50–64), elderly (65–79), or very elderly (≥80). Demographic and clinical characteristics were compared using Chi-square tests and two-sample t-tests. Overall survival (OS) was evaluated using Kaplan–Meier analyses and multivariable Cox proportional hazards models. Results: A total of 1259 patients met inclusion criteria. OS decreased with age. In the 50–64 cohort, subtotal resection (STR) and gross total resection (GTR) significantly improved survival, and radiotherapy provided additional benefit. In the 65–79 cohort, neither resection nor radiotherapy significantly influenced OS. In the ≥80 cohort, STR was associated with worse survival relative to no resection (HR 2.21; p = 0.0349), while GTR and radiotherapy did not improve outcomes. Conclusions: The effect of craniopharyngioma treatment varies by age. Surgery and radiotherapy benefit younger patients, whereas adults aged 65–79 may gain symptomatic but not survival advantages. In patients ≥80, STR may reduce survival, underscoring the need for individualized treatment plans aligned with patient goals and physiological reserve.