In most children with brain tumours, neurosurgical intervention is the first important step in global management. Even though the tumour is only rather infrequently totally cured by surgery, the operation remains an important tool in the symptomatic treatment and allows a histological diagnosis. The extent of the resection is in many tumour types an important prognostic factor. Special attention is paid to the management of hydrocephalus, e g. with neuroendoscopy, and to the limits of the surgical possibilities: (in)operability and completeness of resection. Finally, postoperative care and possible complications are briefly discussed