Clinically, there are features of increased intracranial pressure caused by hydrocephalus. Germ cell tumors are the most common. The CSF or serum PLAP is diagnostic of germinomas and obviates biopsy. Radiotherapy following Stereotactic biopsy is widely practiced. Gross total tumor resection is attempted in patients with radioresistant lesions and in patients with large neoplasms that cause significant mass effect. Superior cerebellar approach for midline tumors and parieto-occipital approach for laterally placed tumors are recommended; the best surgical approach depends on the familiarity of the surgeon, anatomical location and extent of the tumor. In large masses, a combination of an infratentorial and supratentorial approach might be necessary. SRS may be an alternative for elderly patients or patients in poor medical condition and for recurrence.