Brain tumors are the most common form of solid neoplasm of childhood. Progress in the treatment of childhood brain tumors has been frustratingly slow, especially in comparison with other pediatric malignancies. The biology of primary pediatric brain tumors of childhood is just being unraveled. Chemotherapy is a major component of the treatment of many forms of childhood primary central nervous system tumors and is being used in attempts to improve survival and to delay or decrease the amount of radiotherapy needed. Despite the use of more aggressive radiotherapy approaches and intensified chemotherapy approaches, outcome remains dismal for brain stem gliomas and high-grade cortical gliomas. Many unsettled issues exist concerning the treatment of childhood low-grade gliomas.