Recent advances in neurosurgical techniques and diagnostic imaging capabilities have facilitated gross total resection and accurate staging of disease extent in a greater proportion of patients. The addition of chemotherapy to surgery and craniospinal radiation has improved the outcome of patients diagnosed with medulloblastoma. Long-term follow-up studies have documented the neuroendocrine and neuropsychological deficits seen in the survivors. This paper reviews key studies using all three modalities over the past two decades and presents on-going therapeutic strategies using a risk-adapted approach. Further areas of basic research and evolving data on studies in relapsed patients are also briefly discussed.