Brainstem glioma is a malignant childhood brain tumor for which the 'best' treatment approach has not been defined. Many issues concerning the management of these lesions require clarification, including the following. (1) Can patients be reliably separated into risk groups? (2) Is surgery indicated; if so, for which patients? (3) How effective are new radiotherapy regimens? (4) What other forms of treatment are available? This article will attempt to address these management issues.