Precision oncology is established in systemic cancers and brain metastases, but its role in primary CNS tumours is still emerging. Molecular classification has refined the diagnosis and prognosis of gliomas and meningiomas and is increasingly informing treatment. Examples include IDH inhibition in low-grade IDH-mutant glioma, BRAF/MEK inhibition in BRAF-altered glioma and papillary craniopharyngioma, TRK inhibition in NTRK fusion-positive glioma and molecularly stratified trials in recurrent meningioma. Implementation into routine care can be challenging. Primary CNS tumours often require craniotomy for diagnosis, and tissue may be limited particularly for tumours in eloquent areas. The role of repeat biopsy at progression requires careful consideration of value and risk. Access is variable, including timely molecular testing, targeted therapies and clinical trials. Addressing these barriers will be important to realising the promise of CNS precision oncology in Australia.