Remote Recurrent Supratentorial Metastatic Medulloblastoma after Cerebellar Resection without Local Relapse: Reporting a Rare Case

Isolated supratentorial metastasis of cerebellar medulloblastoma is a rarity, and subfrontal recurrences, multiple times over a prolonged period, after gross total resection of the cerebellar lesion and that of metastasis with late spinal dissemination without primary relapse is an even rarer phenomenon. We report first such case, to the best of our knowledge, where a 17-year-old male presented with remote recurrent supratentorial metastasis, multiple times over a prolonged time period. Gross total resection of first supratentorial metastasis was done (second surgery) 3 years after removal of primary cerebellar medulloblastoma (first surgery) and spinal metastasis was seen 5 years after the first surgery, in spite of craniospinal irradiation and chemotherapy. He was tumor-free for 2 years, after which he again had a recurrent lesion in the subfrontal region and underwent excision (third surgery). Six months after the third surgery, he was presented with similar recurrence, and underwent complete resection (fourth surgery), but unfortunately he passed away after 3 months. This case shows that medulloblastomas may recur even after appropriate treatment, in the absence of local relapse. Repeated surgical exploration, radiotherapy, and chemotherapy might benefit patients with a satisfactory clinical course, giving additional few years of survival benefit.