Brainstem gliomas have historically been one of the most difficult pediatric cancers to treat. Tumors arising in the brainstem were once uniformly discounted as surgically unresectable lesions. Early neurosurgeons thought this location to be inoperable and fraught with disaster. The advent of computed tomography (CT), magnetic resonance imaging (MRI), and sophisticated neurophysiological monitoring techniques have significantly advanced the surgical treatment of these precarious lesions.Brainstem gliomas are now recognized as a heterogenous group of tumors. They have been broadly classified into several categories depending upon the classification scheme. All these classification systems provide a framework to predict growth patterns, surgical resectability, and overall prognosis of these tumors. These systems allow the surgeon to obtain a better understanding of the distinction between low-grade tumors and diffuse inoperable tumor types. The authors review the current literature and management of brainstem tumors.