Embryonal tumors, particularly medulloblastomas, are aggressive malignancies affecting children. They pose unique challenges due to their location, high propensity for metastases, and need for irradiating vulnerable developing brains of young children. Diagnostic techniques are incorporating molecular behavior and there is an increasing emphasis on risk stratification for treatment tailoring. Multidisciplinary approach includes cooperation of oncologists (surgeons, pediatric oncologist, radiation oncologists), pathologists, endocrinologists, nutritionists, and several other stakeholders. Prognosis is divergent, and while some tumors still need aggressive management and innovations in targeted therapy to improve control, some others do well in long term, and hence, the focus is more on reducing morbidity by reducing radiation therapy doses and volumes. Several treatment techniques such as highly conformal photon and proton therapies have evolved and are being utilized to achieve this goal. Long-term effects (neurocognitive, endocrine, skeletal) need to be kept in mind when formulating treatment plans, and lifelong monitoring for second neoplasms is necessary.