Intracranial germ cell tumors most commonly present in the pineal and suprasellar regions. Rare cases of brainstem germ cell tumors have been described. Here, we present two cases with brainstem germ cell tumors and review the current literature. The two patients did well, in terms of disease control, but have significant morbidity related to respiratory issues. One patient remains ventilator dependent and the second died from respiratory arrest.