Pediatric brain tumors, especially embryonal and other high-grade tumor types, have the propensity to disseminate along the cerebrospinal fluid (CSF) pathway ,while spread outside the central nervous system (CNS) at diagnosis is very rare. The management of pediatric brain tumors has evolved over the last three decades as a result of prospective multicentric clinical trials. Multimodal treatment including surgical resection, radiotherapy, and chemotherapy has led to improved outcomes in many entities. However, treatment- related toxicity often has a major impact on long-term quality of survival. In order to reduce sequelae, the concept of stratification into risk groups according to clinical variables (e.g., age, presence of metastases detected by imaging or cytological evaluation of CSF, and postoperative residual tumor status) has been developed in the last decades, adjusting the intensity of therapy to the risk of relapse. While the principal treatment strategies have not significantly changed over the past few years, enormous progress has been made in understanding of tumor biology, which has led and most likely will continue to lead to further refinements of risk stratification and to the development of novel therapy approaches using targeted drugs in a personalized way.