Pediatric gliomas, common central nervous system tumors, differ from adult gliomas and are classified as low-grade (LGG) or high-grade (HGG) based on molecular traits. They are further categorized by location: supratentorial, cerebellar, and brainstem, each posing unique surgical challenges. The primary treatment is maximal safe resection, particularly beneficial for low-grade tumors. Advanced imaging and intraoperative tools like neuronavigation and functional MRI are essential to preserve neurological function during surgery. For brainstem gliomas, biopsies are vital for targeted therapies, and laser interstitial thermal therapy (LITT) offers a promising option for certain low-grade lesions. Managing hydrocephalus, often seen in these patients, involves balancing options like endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS). A multidisciplinary approach, integrating surgery, molecular-genetic insights, and technology, is crucial for optimizing outcomes in pediatric glioma management.