Childhood supratentorial malignant gliomas, though less common than those in adults, are responsible for disproportionately high morbidity and mortality rates. Important advances have been made in our ability to diagnose these tumors by noninvasive neuroimaging techniques. In addition, progress has been made in our ability to correlate pathology and biological features with clinical outcomes to provide prognostic information. Neuroimaging and tissue prognostic factors now have important roles which directly affect clinical management. While surgery and radiation therapy are critical components of the treatment of childhood supratentorial gliomas, the role of chemotherapy is less clear. Significant responses have been demonstrated for chemotherapy regimens in infants with malignant gliomas and high-dose chemotherapy and ABMR regimens also produce encouraging response rates. The results of current clinical trials will help us determine if these response rates will translate into prolonged patient survival and allow us to identify subgroups of childhood malignant glioma patients that may benefit from adjuvant chemotherapy.