Importance of patient evaluation for long-term survival in medulloblastoma recurrence

Recurrence is a major cause of death in patients with medulloblastoma. Although the exact protocol for regular radiographic evaluation is sometimes a matter of debate, continuous follow up is necessary. We report a case of long-term survival after surgical removal of a subfrontal recurrent medulloblastoma, which occurred more than 3 years after total gross excision of the primary lesion and radiation therapy. The asymptomatic recurrence, which was detected by routine follow-up neuroimaging tests, was excised. The patient subsequently received gamma knife irradiation of the tumor bed followed by a course of "8 in 1" chemotherapy. "Early delayed radionecrosis" occurred 13 months after gamma knife treatment, which resolved spontaneously. Particularities of the case are discussed with reference to the location of the recurrent tumor, the possible pathogenetic causes and the side effects of treatment. We believe that this case and others reported in the literature underline the importance of continuous MRI surveillance of patients operated on for medulloblastoma.