This review paper provides a detailed examination of the complex molecular mechanisms contributing to the development and progression of neuroblastoma, with a particular emphasis on innovative approaches to diagnosis and treatment. Key molecular changes are analyzed, including telomere maintenance and mutations in the RAS and p53 signaling pathways, which are critical for determining the clinical phenotype and disease outcome. One of the most significant findings is the importance of telomere maintenance for tumor cell survival. Tumors with telomerase activation or the alternative lengthening of telomeres (ALT) pathway exhibit a more aggressive clinical course and poorer prognosis. Innovative diagnostic methods, such as TERT expression analysis and MYCN status, along with MIBG imaging, enable precise patient stratification into risk groups. These methods not only increase diagnostic accuracy but also aid in personalized therapeutic approaches, thereby enhancing treatment efficacy and reducing side effects. In combination with signaling pathway inhibitors, such as ALK inhibitors already in clinical trials, it is possible to significantly improve treatment outcomes. The development of immunotherapies targeting specific molecular changes in the tumor microenvironment, such as CD24, opens new therapeutic possibilities. These new insights allow for the development of combined therapies that target multiple oncogenic pathways simultaneously. Personalized medicine represents a key step in the therapy of neuroblastoma.