Brain and spinal cord tumors represent the most common solid tumors in children. Recent advances in imaging techniques, neurosurgical techniques, chemotherapy approaches, and radiation oncology have resulted in some improvement in overall survival and morbidity. However, the prognosis for many children with high-grade and malignant brain tumors remains guarded in terms of mortality and long-term sequelae. Given the rarity of tumors in children, patients are likely best served at tertiary center that can offer a comprehensive multidiscipline approach.