Medulloblastoma (MB), the most common malignant pediatric brain tumor, has undergone reclassification from a histologically defined disease to a genetically stratified spectrum of distinct subgroups: WNT, SHH, Group 3, and Group 4. Advances in molecular profiling, as captured in the 2021 WHO CNS5 classification, have shown meaningful heterogeneity in terms of tumor biology, prognosis, and therapeutic response. However, translating these insights into precise, less toxic treatments remains an ongoing challenge. This review synthesizes current knowledge on MB subgroup biology, treatment strategies, and emerging therapies such as subgroup-specific inhibitors, immunotherapies, and novel chemotherapeutic regimens. This review also explores risk-adapted approaches while addressing global disparities in access to diagnostics and care. As the field moves toward individualized medicine, closing the gap between molecular understanding and equitable implementation will be crucial to improving outcomes and quality of life for children with medulloblastoma worldwide.