Ependymoma, primitive neuro-ectodermal tumours (PNET), germ cell tumours and other pineal region tumours are uncommon in the adult. Other uncommon adult tumours include gangliogliomas, pleomorphic xanthoastrocytoma, brainstem gliomas and pilocytic astrocytomas. Given the rarity of these tumours, there is no standard treatment for recurrences and patients must be considered on an individual basis. Certainly, low grade tumours such as gangliogliomas and pilocytic astrocytomas are often best managed with re-resection. Some tumours, especially PNET and germ cell tumours, can respond to chemotherapy. Discussion amongst an interdisciplinary CNS tumour group is recommended for many of these patients.